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

• Published in: Gut and liver 2024, 18(6), , pp.970-976
• Main Authors: Lim, Chul-Hyun, Oh, Jung-Hwan
• Format: Article
• Language: English
• Subjects: Adult; Aged; Amoxicillin - administration & dosage; Anti-Bacterial Agents - administration & dosage; bismuth; Bismuth - administration & dosage; Breath Tests; clarithromycin; Clarithromycin - administration & dosage; Drug Administration Schedule; Drug Resistance, Bacterial; Drug Therapy, Combination - methods; Female; Helicobacter Infections - drug therapy; helicobacter pylori; Helicobacter pylori - drug effects; Humans; Male; Metronidazole - administration & dosage; Middle Aged; Original; Peptic Ulcer - drug therapy; Peptic Ulcer - microbiology; Prospective Studies; Proton Pump Inhibitors - administration & dosage; real-time polymerase chain reaction; Treatment Outcome; 내과학
• ISSN: 1976-2283; 2005-1212; 2005-1212
• DOI: 10.5009/gnl230453

: Bismuth-based quadruple therapy (BQT) is a treatment option for clarithromycin-resistant (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. : 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 C-urea breath test. Eradication and adverse event rates of the two groups were assessed. : 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. : 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.