{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T03:23:01Z","timestamp":1779160981699,"version":"3.51.4"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Helicobacter"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Eradication of\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>Helicobacter pylori<\/jats:italic>\n                      <\/jats:styled-content>\n                      remains challenging in countries with high antimicrobial resistance and limited access to bismuth\u2010based therapies. Quinolone\u2010containing regimens represent a practical alternative, yet comparative data between levofloxacin\u2010 and moxifloxacin\u2010based nitazoxanide quadruple therapies are scarce, particularly in Egypt. This multicenter trial evaluated the efficacy, safety, and tolerability of two nitazoxanide\u2010based second\u2010line regimens after failure of first\u2010line eradication therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this prospective, randomized, single\u2010blind, parallel\u2010group study conducted at six Egyptian centers, adults aged 18\u201370\u2009years with documented failure of first\u2010line\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>H. pylori<\/jats:italic>\n                      <\/jats:styled-content>\n                      therapy were enrolled. Patients were randomized 1:1 to receive either LNDL (levofloxacin 750\u2009mg once daily, nitazoxanide 500\u2009mg twice daily, doxycycline 100\u2009mg twice daily, lansoprazole 30\u2009mg twice daily) or MNDL (moxifloxacin 400\u2009mg once daily with the same adjunct medications) for 14\u2009days. Eradication was assessed using a stool antigen test \u2265\u20094\u2009weeks after treatment. Safety, tolerability, and symptom improvement were recorded. Analyses were performed using both intention\u2010to\u2010treat (ITT) and per\u2010protocol (PP) populations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 430 patients were randomized. ITT eradication rates were 65.6% (95% CI: 59.2% \u2013 72%) for LNDL and 74.9% (95% CI: 69% \u2013 80.7%) for MNDL (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.035). PP eradication rates were 70.9% (95% CI: 64.5% \u2013 77.2%) and 78.5% (95% CI: 72.9% \u2013 84.2%), respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.076). Among patients previously treated with levofloxacin, MNDL achieved significantly higher eradication rates than LNDL (65.8%, 95% CI: 50\u201381.6 vs. 42.6%, 95% CI: 29\u201356.2,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028). Both regimens produced significant symptom improvement and were well tolerated; no serious adverse events occurred.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both nitazoxanide\u2010based quinolone quadruple regimens demonstrated modest but clinically relevant efficacy as second\u2010line therapy. Moxifloxacin showed superior performance in patients with prior levofloxacin exposure. These findings support the use of moxifloxacin\u2010based rescue therapy in settings with high resistance and limited access to bismuth\u2010containing regimens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hel.70104","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:38:12Z","timestamp":1767785892000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy and Safety of Levofloxacin\u2010 Versus Moxifloxacin\u2010Based Nitazoxanide Quadruple Therapy as Second\u2010Line Treatment for\n                    <scp>\n                      <i>Helicobacter pylori<\/i>\n                    <\/scp>\n                    in Egypt: A Randomized Multicenter Trial"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6776-1371","authenticated-orcid":false,"given":"Gasser","family":"El\u2010Azab","sequence":"first","affiliation":[{"name":"Hepatology and Gastroenterology Department, National Liver Institute Menoufia University  Menoufia Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4366-2218","authenticated-orcid":false,"given":"Sherief","family":"Abdel Salam","sequence":"additional","affiliation":[{"name":"Tropical Medicine Department, Faculty of Medicine Tanta University  Tanta Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9805-3850","authenticated-orcid":false,"given":"Ehab","family":"Moustafa","sequence":"additional","affiliation":[{"name":"Tropical Medicine and Gastroenterology Department, Faculty of Medicine Assiut University  Assiut Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6243-1768","authenticated-orcid":false,"given":"Ahmed","family":"Abuoelhassan","sequence":"additional","affiliation":[{"name":"Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine Al\u2010Azhar University  Cairo Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7429-465X","authenticated-orcid":false,"given":"Ayman","family":"Shamseya","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine University of Alexandria  Alexandria Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6693-9112","authenticated-orcid":false,"given":"Ahmed","family":"Ellakany","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine University of Alexandria  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