Second-line Treatment

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Levofloxacin Quadruple Therapy (14 days)

40 mg esomeprazole b.i.d.

120 mg bismuth subcitrate q.i.d.

1 g amoxicillin* b.i.d.

250 mg levofloxacin** b.i.d.

[*400 mg metronidazole t.i.d. may be used in patients with penicillin allergy]

[**For safety advice on prescribing flouroquinolones, please see the following link: https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/drug-interactions/fluoroquinolone-warning-2019.html]

Please ensure there are no contraindications to any of the medications above.

Remember to schedule a post-eradication Urea breath test 4-6 weeks following completion of therapy. If the Urea breath test is unavailable, a stool antigen test may be used if locally validated.