[Helicobacter pylori: what eradication regimen in a tropical area after the failure of two separate lines of eradication including metronidazole and clarithromycin?]. / Helicobacter pylori : quel traitement d'éradication en cas d'échec de deux lignes de traitement comprenant le métronidazole et la clarithromycine en zone tropicale ?

Helicobacter pylori (H. pylori) resistance against antibiotics is a major challenge, particularly in developing countries. We report a case of H. pylori infection where eradication by two lines of treatment, one including metronidazole and the other clarithromycin, failed, and discuss the management of such a case in a tropical area. This 55-year-old man complained of epigastric pain dating back for three years. A stool antigen test for H. pylori was positive. First-line eradication therapy, which combined a proton pump inhibitor, amoxicillin and metronidazole, was unsuccessful, as was the second-line therapy, which replaced metronidazole by clarithromycin. Third-line treatment, which still included a proton pump inhibitor and amoxicillin but added levofloxacin was successful. A stool antigen test to verify eradication was finally negative. In developing countries, H. pylori eradication must be managed rationally. In particular, fluoroquinolones must be reserved for treatment failure. The stool antigen test appears to be a useful and economical alternative to the urea breath test for verifying eradication.