Second and third line treatment options for Helicobacter pylori eradication

Table 1 Summary of consensus reports on Helicobacter pylori therapy

Region	Consensus title	Year	1st line treatment recommendations	Salvage therapy recommendations	Ref.
South America	3rd Brazilian consensus	2013	PPI + amoxicillin 1 g and clarithromycin 500 mg twice daily for 7 d(Replace amoxicillin with furazolidone 200 mg twice daily for penicillin allergy)	PPI + levofloxacin 500 mg once daily + amoxicillin 1 g twice daily for 10 dorPPI + levofloxacin 500 mg once daily + furazolidone 400 mg once daily for 7-10 dorbismuth-based quadruple therapy for 10-14 d	[7]
24 countries: United Kingdom United States Spain Italian Germany France Ireland etc.	Management of Helicobacter pylori infection-the maastricht IV/florence consensusreport	2012	If clarithromycin resistance rate < 20%:PPI + amoxicillin + clarithromycinorbismuth-based quadruple therapy(Replace amoxicillin with metronidazole for penicillin allergy)If clarithromycin resistance rate > 20%:Bismuth-based quadruple therapyorNon-bismuth quadruple therapy (sequential/concomitant therapy)	2nd line rescue:if clarithromycin resistance rate < 20%:bismuth-based quadruple therapyorPPI + levofloxacin + amoxicillinif clarithromycin resistance rate > 20%:PPI + levofloxacin + amoxicillin3rd line rescue:antibiotic susceptibility test first	[6]
Global	Helicobacter pylori in developing countriesWorld Gastroenterology Organization Global Guideline	2011	PPI + amoxicillin + clarithromycin(replace amoxicillin with metronidazole for penicillin allergy)orbismuth-based quadruple therapy	Bismuth-based quadruple therapyorPPI + levofloxacin + amoxicillin	[8]
Asia Pacific	Second Asia-Pacific Consensus Guidelines for Helicobacter pylori infection	2009	PPI + amoxicillin + clarithromycin for 7 dorbismuth-based quadruple therapy	PPI-amoxicillin-metronidazole_orbismuth-based quadruple therapyorlevofloxacin-based triple therapyorrifabutin-based triple therapy	[1]
Japan	Guidelines for the Management of Helicobacter pylori Infection in Japan: 2009 Revised Edition	2009	PPI + amoxicillin + clarithromycin for 7 d	2nd line rescue:PPI + amoxicillin + metronidazole for 5-10 d3rd line rescue:PPI + amoxicillin + levofloxacin	[9]
Latin America	Latin-American Consensus Conference on Helicobacter pylori infection	2000	Omeprazole 20 mg, or lansoprazole 30 mg, or pantoprazole 40 mg, or rabeprazole 20 mg + clarithromycin 500 mg + amoxicillin 1000 mg twice a day for 7–14 d (preferably 10 d)	No specific recommendations	[10]

PPI: Proton pump inhibitor.