esomeprazole + amoxicillin + levofloxacin + metronidazole

Levofloxacin-based sequential therapy is a specific antibiotic regimen developed and studied by National Taiwan University Hospital for the treatment of refractory *Helicobacter pylori* infection. This 10-day sequential treatment is divided into two phases: an initial 5-day phase consisting of esomeprazole (a proton pump inhibitor) and amoxicillin, followed by a 5-day phase consisting of esomeprazole, levofloxacin (a fluoroquinolone antibiotic), and metronidazole (a nitroimidazole antibiotic). The regimen is designed as a second-line salvage therapy to overcome antibiotic resistance, particularly in patients who have failed standard first-line treatments. Levofloxacin provides bactericidal activity by inhibiting bacterial DNA gyrase and topoisomerase IV, while the other components work synergistically to inhibit cell wall synthesis and disrupt bacterial DNA structure.

Brand names

Cravit

Other names

levofloxacin-based sequential therapyCravit-based sequential therapySequential Therapy for Refractory H. Pylori