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Randomized Controlled Trial
. 2024 Nov 15;18(6):970-976.
doi: 10.5009/gnl230453. Epub 2024 May 7.

Bismuth-Based Quadruple Therapy as First-Line Treatment for Clarithromycin-Resistant Helicobacter pylori Infection: A Prospective Randomized Comparison of 7- and 14-Day Treatment Regimens

Chul-Hyun Lim  1 , Jung-Hwan Oh  1
Affiliations
Randomized Controlled Trial

Bismuth-Based Quadruple Therapy as First-Line Treatment for Clarithromycin-Resistant Helicobacter pylori Infection: A Prospective Randomized Comparison of 7- and 14-Day Treatment Regimens

Chul-Hyun Lim et al. Gut Liver. .

Abstract

Background/aims: : Bismuth-based quadruple therapy (BQT) is a treatment option for clarithromycin-resistant Helicobacter pylori (HP) infection. The aim of this study was to compare the efficacy of 7-day BQT with that of 14-day BQT as first-line treatment for clarithromycin-resistant HP infection.

Methods: : A total of 162 treatment-naïve patients with peptic ulcer disease and clarithromycin-resistant HP infection confirmed by real-time polymerase chain reaction (RT-PCR) were enrolled. The enrolled patients were prospectively randomized to receive BQT for either 7 or 14 days of treatment. Eradication of HP infection was assessed using a 13C-urea breath test. Eradication and adverse event rates of the two groups were assessed.

Results: : The overall eradication rates in the intention-to-treat (ITT) and per-protocol (PP) analyses were 83.0% (95% confidence interval [CI], 77.2% to 88.9%; 132/159) and 89.8% (95% CI, 84.9% to 94.7%; 132/147), respectively. The eradication rates in the ITT analysis were 79.0% (64/81) in the 7-day group and 87.2% (68/78) in the 14-day group (p=0.170). The eradication rates in the PP analysis were 86.5% (64/74) in the 7-day group and 93.2% (68/73) in the 14-day group (p=0.182). Clinically significant adverse events occurred in 18.2% of patients. There was no statistically significant difference in the rates of individual or all adverse events between the two groups.

Conclusions: : Both 7-day and 14-day BQT were effective and safe as first-line therapy for HP infections identified as resistant to clarithromycin by RT-PCR. For clarithromycin-resistant HP infections, 7-day BQT may be sufficient as first-line therapy.

Keywords: Bismuth; Breath tests; Clarithromycin; Helicobacter pylori; Real-time polymerase chain reaction.

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Conflict of interest statement

CONFLICTS OF INTEREST

This work was supported by Il-Yang Pharm. Co., Ltd. Except for that, no potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Study flowchart. ITT, intention-to-treat; PP, per-protocol analysis.
Fig. 2
Fig. 2
Eradication rates of the two study groups. ITT, intention-to-treat; PP, per-protocol analysis.
See this image and copyright information in PMC

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