Kong S, Huang K, Wang J, et al. - For Helicobacter pylori eradication, levofloxacin- and bismuth-based quadruple therapy (LBQT) is recommended after the failure of clarithromycin- and bismuth-based quadruple therapy (CBQT). The efficacy of second-line tailored bismuth-based quadruple therapy (TBQT) vs empirical LBQT were assessed in this study. Researchers randomized patients for whom CBQT failed to take 14 days of TBQT or LBQT. Endoscopy was performed in all patients for culture-based antibiotic susceptibility testing. Randomization of patients in the TBQT group showing levofloxacin susceptibility was done to receive amoxicillin, levofloxacin, esomeprazole, and colloidal bismuth pectin (ALEB) or amoxicillin, furazolidone, esomeprazole, and colloidal bismuth pectin (AFEB) for 14 days; patients resistant to levofloxacin were provided AFEB. Outcomes suggest higher effectiveness of TBQT vs LBQT as a second-line strategy following failure of CBQT. They suggest using amoxicillin, furazolidone, esomeprazole, and colloidal bismuth pectin (AFEB) therapy as a rescue therapy in the absence of antibiotic susceptibility testing to eradicate H. pylori and avoid levofloxacin resistance.