• Siya Kong, Han Chen, Keting Huang, Duochen Jin, Guoxin Zhang, and Feng Ye.
• Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University.
• Medicine (Baltimore). 2021 Mar 12; 100 (10): e24915e24915.

RationaleAntibiotic resistance poses a challenge for Helicobacter pylori eradication treatment. Current guidelines strongly recommend avoiding repeated treatments with the same antibiotic to prevent the emergence of drug resistance. However, for penicillin-allergic patients with recurrent H. pylori eradication failures, avoiding repeated treatments with the same antibiotic severely limits the choice of treatment.Patient ConcernsA 47-year-old woman with a penicillin allergy for whom 2 previous levofloxacin and bismuth-based therapies had failed.DiagnosisH. pylori infection.InterventionsAgar dilution susceptibility testing and gene sequence analysis was performed to confirm levofloxacin susceptibility again. Therefore, we treated her with a 14-day regimen consisting of levofloxacin (500 mg once daily), furazolidone (100 mg twice daily), colloidal bismuth pectin (220 mg twice daily), and esomeprazole (20 mg twice daily).OutcomesThe patient was successfully treated with a third levofloxacin and bismuth-based regimen.LessonsAntibiotics included in previous failed therapies need not be eliminated if no antibiotic resistance is found on antimicrobial susceptibility testing.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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