Since the human pathogen Helicobacter pylori was recognized as the most important aetiologic agent of chronic gastritis and as a major factor for peptic ulcer pathogenesis, the therapeutic approach to these common diseases has completely changed. 1 It has been well documented that H. pylori eradication not only heals duodenal ulcers, but also results in a marked decrease of peptic ulcer recurrence. 2 Despite the importance of H. pylori eradication in the management of a variety of upper gastrointestinal tract diseases and the many advances in eradication therapy over the last few years, treatment failure remains a signi®cant problem, eradication rates still being roughly 70±80%. The suggested ®rst line therapies for H. pylori eradication are based on an antisecretory agent (a proton pump inhibitor or ranitidine bismuth citrate) and two antibiotics in association for 7 days, while as far as second line therapies are concerned, i.e. in the case of treatment failure, a variety of agents have been employed, but large scale trials have not been conducted to establish the optimal regimen. 3±7 Major causes of failure may be poor patient compliance (many tablets have to be taken per day and/or side-effects may occur), inappropriate treatment prescription, and ®nally, the presence of a primary, or the development of a secondary, resistance to strains. 8 Because the development of antibiotic resistant strains is one of the major SUMMARY Background: Helicobacter pylori eradication therapies do not achieve 100% success rates. Antibiotic resistant strains are among the major causes of failure. Current recommendations concerning the management of treatment failures are not fully clear. Aim: To evaluate the ef®cacy of a multi-step therapeutic strategy in a large group of infected patients. Methods: A total of 2606 H. pylori-positive patients were administered tinidazole, clarithromycin and a proton pump inhibitor for 1 week. Patients with continuing infection were then given a second 1-week course of amoxycillin, clarithromycin and ranitidine bismuth citrate. Patients still infected after the second course underwent upper gastrointestinal endoscopy with H. pylori culture, and then received a 1-week

One-week regimens consisting of RBC plus clarithromycin and either tinidazole or amoxycillin, combine high eradication rates with modest side-effects. No substantial difference was found between the two treatment regimens tested in this trial.

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