SUMMARYAim: To test the efficacy of rabeprazole, levofloxacin and rifabutin triple therapy vs. quadruple therapy for the second-line treatment of Helicobacter pylori infection. Methods: One hundred and nine patients who had failed previous H. pylori eradication were randomized to receive: (i) rabeprazole, 20 mg b.d., rifabutin, 300 mg once daily, and levofloxacin, 500 mg once daily, for 7 days (triple therapy); or (ii) rabeprazole, 20 mg b.d., metronidazole, 400 mg t.d.s., bismuth subcitrate, 120 mg q.d.s., and tetracycline, 500 mg q.d.s., for 7 days (quadruple therapy). Endoscopy and culture were performed before treatment. Results:The clarithromycin (79% vs. 21%, P < 0.001) and metronidazole (89% vs. 40%, P < 0.001) resistance rates were significantly higher in patients with previous exposure than in those with no previous exposure. The intention-to-treat and per protocol eradication rates were 91%/91% for the triple therapy group and 91%/92% for the quadruple therapy group. For patients with double resistance to metronidazole and clarithromycin, the eradication rates were 85% (17/20) in the triple therapy group and 87% (13/15) in the quadruple therapy group. Compliance was greater than 95% for both regimens. Conclusion: Rabeprazole, levofloxacin and rifabutinbased triple therapy and quadruple therapy were equally effective as second-line treatments for H. pylori infection.

SUMMARY AimTo test the efficacy of levofloxacin-based second-line therapy for resistant Helicobacter pylori infection. MethodsOne hundred and six patients who failed H. pylori eradication were randomized to receive (i) lansoprazole 30 mg, amoxicillin 1 g, levofloxacin 500 mg, all given twice daily for 7 days (LAL); or (ii) lansoprazole 30 mg twice daily, metronidazole 400 mg thrice daily, bismuth subcitrate 120 mg and tetracycline 500 mg four times daily for 7 days (quadruple). Post-treatment H. pylori status was determined by 13 C-urea breath test. ResultsIntention-to-treat and per-protocol H. pylori eradication rates were 57/ 60% for the LAL group and 71/76% for the quadruple group respectively. Metronidazole, clarithromycin, amoxicillin and levofloxacin resistance were found in 76%, 71%, 0% and 18% of patients, respectively. Levofloxacin resistance led to treatment failure in the LAL group. For patients with dual resistance to metronidazole and clarithromycin, the eradication rates were 79% in the LAL group (levofloxacin-sensitive) and 65% in the quadruple group (P ¼ 0.34). ConclusionLansoprazole, amoxicillin plus levofloxacin second-line therapy is comparable with quadruple therapy in efficacy. Subjects, especially those with dual resistance to metronidazole and clarithromycin, may consider levofloxacin-based therapy for levofloxacin-sensitive strains.

Background: Chinese tea has an antibacterial activity against a wide range of bacteria. However, its activity against Helicobacter pylori has not been reported. Method: In this study the anti‐Helicobacter pylori effects of a Chinese tea (Lung Chen tea), and two tea catechins, epigallocatechin gallate and epicatechin and their minimum inhibitory concentrations (MICs) were examined. The effect of Lung Chen on metronidazole resistance was also studied using the E‐test. Results: Lung Chen, epigallocatechin gallate and epicatechin all inhibited the growth of H. pylori. The MIC90 for Lung Chen was 0.25–0.5% (w/w) and that of epigallocatechin gallate and epicatechin were 50–100 and 800–1600 μg/mL, respectively. Epigallocatechin gallate is probably the active ingredient responsible for most of the anti‐H. pylori activity of Chinese tea. Lung Chen did not reverse metronidazole resistance. Conclusions: Chinese tea has anti‐H. pylori activity in a daily consumed concentration, and epigallocatechin gallate is probably the active ingredient responsible for the action.

INTRODUCTIONIn the Asia-Paci®c consensus conference on the management of Helicobacter pylori infection, the recommended regimens included the use of a proton pump inhibitor at a standard dose, plus two antibiotics (clarithromycin, amoxicillin or metronidazole), each given twice daily for 7 days. This regimen should attain a per protocol eradication rate of at least 90%, or an intention-to-treat eradication rate of at least 80%. 1 The high eradication rates of these combinations have been con®rmed in Western countries. 2,3 In the MACH 1 study, the regimen using omeprazole plus amoxicillin, 1000 mg, and clarithromycin, 500 mg (OAC), all given twice daily, was one of the most effective regimens, with an intention-to-treat eradication rate of 91%. 2 The high ef®cacy of this lowdose clarithromycin regimen was con®rmed by the SUMMARY Background: Rabeprazole is a new proton pump inhibitor with more potent acid suppressive and antiHelicobacter effects. Aim: To compare two different regimens of rabeprazolebased triple therapy vs. 7-day omeprazole-based triple therapy for the eradication of Helicobacter pylori infection. Method: Patients with proven H. pylori infection were randomized to receive: (i) 7-day rabeprazole, 10 mg, amoxicillin, 1000 mg, and clarithromycin, 500 mg, all twice daily; (ii) 3-day rabeprazole, 20 mg, amoxicillin, 1000 mg, and clarithromycin, 500 mg, all twice daily; or (iii) 7-day omeprazole, 20 mg, amoxicillin, 1000 mg, and clarithromycin, 500 mg, all twice daily. Endoscopy (CLO test, histology) was performed before randomization and 6 weeks after drug treatment.