Statement 16: After failure of first-line treatment with bismuth quadruple and second-line treatment with fluoroquinolone-containing therapy, it is recommended to use a clarithromycin-based triple or quadruple therapy only if from an area of low (<15%) clarithromycin resistance. Otherwise, a high-dose PPI-amoxicillin dual therapy, a rifabutin-containing regimen or a combination of bismuth with different antibiotics should be used.
Agreement 90% Grade C2