Moxifloxacin-based triple therapy is a safe and well-tolerated option in anti-H. pylori therapy. In second-line treatment, the combination of a PPI, moxifloxacin, and metronidazole or tinidazole is a valid option, especially in countries where bismuth salts are unavailable. In first-line therapy, a moxifloxacin-based triple therapy cannot generally be recommended. However, under specific circumstances, this combination might be considered as an individual first-line treatment option. Thus, in a population with low primary quinolone resistance and high primary clarithromycin resistance, a PPI triple therapy with moxifloxacin and metronidazole or tinidazole could be a valuable alternative