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The efficacy of bismuth containing quadruple therapy as a first-line treatment option for Helicobacter pylori.

Abstract

BACKGROUND

Helicobacter pylori eradication rates have tended to decrease recently, mostly due to increasing antibiotic-resistance. The present study aimed to compare the efficacy of bismuth-based quadruple regimen with proton pump inhibitor-based triple regimen for eradication of H. pylori.

METHODS

Consecutive H. pylori-positive patients with non-ulcer dyspepsia were randomized into one of two regimens: (i) bismuth subsalicylate 300 mg q.i.d., lansoprazole 30 mg b.i.d., tetracycline 500 mg q.i.d. and metronidazole 500 mg t.i.d. (BLTM group) for 14 days; (ii) lansoprazole 30 mg b.i.d., amoxicillin 1 g b.i.d and clarithromycin 500 mg b.i.d. (LAC) for 14 days. Gastroscopy and (14)C-Urea breath test (UBT) were performed before enrollment, and UBT only was repeated for 6 weeks after treatment.

RESULTS

A total of 240 patients were randomized into groups and 212 of them completed the protocols. The 'intention-to-treat' (ITT) and 'per protocol' (PP) H. pylori eradication rates were 70% (95%CI 61-78) and 82.3% (95%CI 74-89) in the BLTM group, and 57.5% (95%CI 48-66) and 62.7% (95%CI 53-71) in the LAC group. The BLTM treatment achieved a significantly better eradication rate compared with LAC treatment in PP analysis (82.3% vs. 62.7%, P = 0.002). Mild to severe side-effects, which were more frequent in the BLTM group, were reported in 18.2% of the patients.

CONCLUSION

The bismuth-based quadruple regimen achieved a better eradication rate compared with proton pump inhibitor-based triple regimens as a first-line eradication option for H. pylori in our population.

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  • Authors+Show Affiliations

    ,

    Department of Gastroenterology, Gulhane Military Medical Academy, Ankara, Turkey.

    , , ,

    Source

    Journal of digestive diseases 8:4 2007 Nov pg 211-5

    MeSH

    2-Pyridinylmethylsulfinylbenzimidazoles
    Adult
    Aged
    Amoxicillin
    Anti-Bacterial Agents
    Anti-Ulcer Agents
    Bismuth
    Breath Tests
    Clarithromycin
    Drug Therapy, Combination
    Dyspepsia
    Gastroscopy
    Helicobacter Infections
    Helicobacter pylori
    Humans
    Lansoprazole
    Metronidazole
    Middle Aged
    Single-Blind Method
    Statistics, Nonparametric
    Tetracycline
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    17970879

    Citation

    Uygun, Ahmet, et al. "The Efficacy of Bismuth Containing Quadruple Therapy as a First-line Treatment Option for Helicobacter Pylori." Journal of Digestive Diseases, vol. 8, no. 4, 2007, pp. 211-5.
    Uygun A, Kadayifci A, Safali M, et al. The efficacy of bismuth containing quadruple therapy as a first-line treatment option for Helicobacter pylori. J Dig Dis. 2007;8(4):211-5.
    Uygun, A., Kadayifci, A., Safali, M., Ilgan, S., & Bagci, S. (2007). The efficacy of bismuth containing quadruple therapy as a first-line treatment option for Helicobacter pylori. Journal of Digestive Diseases, 8(4), pp. 211-5.
    Uygun A, et al. The Efficacy of Bismuth Containing Quadruple Therapy as a First-line Treatment Option for Helicobacter Pylori. J Dig Dis. 2007;8(4):211-5. PubMed PMID: 17970879.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The efficacy of bismuth containing quadruple therapy as a first-line treatment option for Helicobacter pylori. AU - Uygun,Ahmet, AU - Kadayifci,Abdurrahman, AU - Safali,Mukerrem, AU - Ilgan,Seyfettin, AU - Bagci,Sait, PY - 2007/11/1/pubmed PY - 2008/1/5/medline PY - 2007/11/1/entrez SP - 211 EP - 5 JF - Journal of digestive diseases JO - J Dig Dis VL - 8 IS - 4 N2 - BACKGROUND: Helicobacter pylori eradication rates have tended to decrease recently, mostly due to increasing antibiotic-resistance. The present study aimed to compare the efficacy of bismuth-based quadruple regimen with proton pump inhibitor-based triple regimen for eradication of H. pylori. METHODS: Consecutive H. pylori-positive patients with non-ulcer dyspepsia were randomized into one of two regimens: (i) bismuth subsalicylate 300 mg q.i.d., lansoprazole 30 mg b.i.d., tetracycline 500 mg q.i.d. and metronidazole 500 mg t.i.d. (BLTM group) for 14 days; (ii) lansoprazole 30 mg b.i.d., amoxicillin 1 g b.i.d and clarithromycin 500 mg b.i.d. (LAC) for 14 days. Gastroscopy and (14)C-Urea breath test (UBT) were performed before enrollment, and UBT only was repeated for 6 weeks after treatment. RESULTS: A total of 240 patients were randomized into groups and 212 of them completed the protocols. The 'intention-to-treat' (ITT) and 'per protocol' (PP) H. pylori eradication rates were 70% (95%CI 61-78) and 82.3% (95%CI 74-89) in the BLTM group, and 57.5% (95%CI 48-66) and 62.7% (95%CI 53-71) in the LAC group. The BLTM treatment achieved a significantly better eradication rate compared with LAC treatment in PP analysis (82.3% vs. 62.7%, P = 0.002). Mild to severe side-effects, which were more frequent in the BLTM group, were reported in 18.2% of the patients. CONCLUSION: The bismuth-based quadruple regimen achieved a better eradication rate compared with proton pump inhibitor-based triple regimens as a first-line eradication option for H. pylori in our population. SN - 1751-2972 UR - https://www.unboundmedicine.com/medline/citation/17970879/The_efficacy_of_bismuth_containing_quadruple_therapy_as_a_first_line_treatment_option_for_Helicobacter_pylori_ L2 - https://doi.org/10.1111/j.1751-2980.2007.00308.x DB - PRIME DP - Unbound Medicine ER -