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  1. Marco Romano1,
  2. Gerardo Nardone2
  1. 1Department of Medicine-Gastroenterology, Second University of Naples, Italy
  2. 2Department of Medicine-Gastroenterology, Federico II University, Naples, Italy
  1. Correspondence to Marco Romano, Second University of Naples, Dipartimento di Internistica Clinica e Sperimentale-Gastroenterology Unit, c/o II Policlinico, ‘Edificio 3, 4o piano’, 80131 Napoli, Italy; marco.romano{at}

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We thank Drs Molina-Infante and Gisbert1 for their letter and for their appreciation of our study.2 We completely agree that the discrepancy between their study and our study as to the efficacy of levofloxacin-containing sequential treatment in Helicobacter pylori eradication might be at least in part due to the very low (ie, 3%) prevalence of H pylori strains resistant to this antimicrobial in our region compared with their geographical area. We also agree that clarithromycin-containing sequential treatment is achieving disappointing results in areas with a high prevalence of clarithromycin and/or dual (ie, metronidazole + clarithromycin) resistance and that, therefore, its role in this setting should be critically reconsidered.

Recently, a study by Hsu et al has demonstrated high efficacy of a 14-day sequential–concomitant hybrid treatment (ie, proton pump inhibitor (PPI) standard dose twice daily + amoxicillin 1 g twice daily for 7 days followed by a further 7 days of PPI + amoxicillin 1 g …

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  • Linked articles 231233, 233015.

  • Competing interests None.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

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