Reviewer’s report
Title:  Cefuroxime,  levofloxacin,  esomeprazole,  and  bismuth  as  first-line  Helicobacter  pylori  
eradication therapy in patients allergic to penicillin
Version: 2 Date: 05 Apr 2019
Reviewer: Hideki Mori
Reviewer's report:
Comment　1
Authors showed the efficacy of cefuroxime, levofloxacin, esomeprazole, and bismuth as first-line  
Helicobacter pylori eradication therapy in patients allergic to penicillin. 
The efficacy of this regimen achieved cure rates, safety, and compliance, however, the impact is lost by  
limited samples of antibacterial sensitivity test. The numbers of cefuroxime resistant and levofloxacin  
susceptible strains and cefuroxime resistant and levofloxacin resistant strains were too low. Thus, it is  
difficult to evaluate the relationship between cefuroxime resistance and successful eradication. 
Comment　2
Other studies have concluded the efficacy of fourth-generation quinolones, including moxifloxacin,  
sitafloxacin,  gemifloxacin,  and  gatifloxacin,  which  have  broad-spectrum  antibacterial  activity  
containing regimen. The low efficacy of levofloxacin containing regimens for levofloxacin resistant  
strains or gyrA mutation positive strains was shown. Authors should discuss about this point.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional  
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further  
assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If  
your reply is yes to any, please give details below.
None
I agree to the open peer review policy of the journal. I understand that my name will be included on my  
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. I agree for my 
report to be made available under an Open Access Creative Commons CC-BY license 
(http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not  
be published.
I agree to the open peer review policy of the journal
Reviewer’s report
Title:  Cefuroxime,  levofloxacin,  esomeprazole,  and  bismuth  as  first-line  Helicobacter  pylori  
eradication therapy in patients allergic to penicillin
Version: 2 Date: 05 Apr 2019
Reviewer: Hideki Mori
Reviewer's report:
Comment　1
Authors showed the efficacy of cefuroxime, levofloxacin, esomeprazole, and bismuth as first-line  
Helicobacter pylori eradication therapy in patients allergic to penicillin. 
The efficacy of this regimen achieved cure rates, safety, and compliance, however, the impact is lost by  
limited samples of antibacterial sensitivity test. The numbers of cefuroxime resistant and levofloxacin  
susceptible strains and cefuroxime resistant and levofloxacin resistant strains were too low. Thus, it is  
difficult to evaluate the relationship between cefuroxime resistance and successful eradication. 
Comment　2
Other studies have concluded the efficacy of fourth-generation quinolones, including moxifloxacin,  
sitafloxacin,  gemifloxacin,  and  gatifloxacin,  which  have  broad-spectrum  antibacterial  activity  
containing regimen. The low efficacy of levofloxacin containing regimens for levofloxacin resistant  
strains or gyrA mutation positive strains was shown. Authors should discuss about this point.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional  
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further  
assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If  
your reply is yes to any, please give details below.
None
I agree to the open peer review policy of the journal. I understand that my name will be included on my  
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. I agree for my 
report to be made available under an Open Access Creative Commons CC-BY license 
(http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not  
be published.
I agree to the open peer review policy of the journal
Please review this paper.
user
Reviewer’s report
Title:  Cefuroxime,  levofloxacin,  esomeprazole,  and  bismuth  as  first-line  Helicobacter  pylori  
eradication therapy in patients allergic to penicillin
Version: 2 Date: 05 Apr 2019
Reviewer: Hideki Mori
Reviewer's report:
Comment　1
Authors showed the efficacy of cefuroxime, levofloxacin, esomeprazole, and bismuth as first-line  
Helicobacter pylori eradication therapy in patients allergic to penicillin. 
The efficacy of this regimen achieved cure rates, safety, and compliance, however, the impact is lost by  
limited samples of antibacterial sensitivity test. The numbers of cefuroxime resistant and levofloxacin  
susceptible strains and cefuroxime resistant and levofloxacin resistant strains were too low. Thus, it is  
difficult to evaluate the relationship between cefuroxime resistance and successful eradication. 
Comment　2
Other studies have concluded the efficacy of fourth-generation quinolones, including moxifloxacin,  
sitafloxacin,  gemifloxacin,  and  gatifloxacin,  which  have  broad-spectrum  antibacterial  activity  
containing regimen. The low efficacy of levofloxacin containing regimens for levofloxacin resistant  
strains or gyrA mutation positive strains was shown. Authors should discuss about this point.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional  
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further  
assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If  
your reply is yes to any, please give details below.
None
I agree to the open peer review policy of the journal. I understand that my name will be included on my  
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. I agree for my 
report to be made available under an Open Access Creative Commons CC-BY license 
(http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not  
be published.
I agree to the open peer review policy of the journal
assistant