The “three‐in‐one” formulation of bismuth quadruple therapy for Helicobacter pylori eradication with or without probiotics supplementation: Efficacy and safety in daily clinical practice

• Published in: Helicobacter (Cambridge, Mass.) Mass.), 2018-08, Vol.23 (4), p.e12502-n/a
• Main Authors: Zagari, Rocco Maurizio, Romiti, Alessandra, Ierardi, Enzo, Gravina, Antonietta G., Panarese, Alba, Grande, Giuseppe, Savarino, Edoardo, Maconi, Giovanni, Stasi, Elisa, Eusebi, Leonardo Henry, Farinati, Fabio, Conigliaro, Rita, Bazzoli, Franco, Romano, Marco
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Bismuth; Bismuth - administration & dosage; Bismuth - adverse effects; bismuth quadruple therapy; Clinical medicine; Clinical trials; Compliance; Confidence intervals; Drug Therapy, Combination - adverse effects; Effectiveness; Eradication; Female; Helicobacter Infections - drug therapy; Helicobacter Infections - microbiology; Helicobacter pylori; Helicobacter pylori - drug effects; Helicobacter pylori - physiology; Histology; Humans; Italy; Male; Medical research; Metronidazole - administration & dosage; Metronidazole - adverse effects; Middle Aged; Motivation; Patients; Probiotics; Probiotics - administration & dosage; Probiotics - adverse effects; probiotics supplementation; Proton Pump Inhibitors - administration & dosage; Proton Pump Inhibitors - adverse effects; Pylera(R); Retrospective Studies; Safety; Supplements; Tetracycline - administration & dosage; Tetracycline - adverse effects; Therapy; Urea
• ISSN: 1083-4389; 1523-5378
• DOI: 10.1111/hel.12502

Background Clinical trials have shown a good efficacy of the “three‐in‐one” formulation of bismuth quadruple therapy (BQT) for Helicobacter (H.) pylori eradication. We aimed to assess the efficacy and safety of the three‐in‐one BQT in clinical practice, and investigate the effect of probiotic supplementation, in Italy. Materials and Methods A retrospective database, multicentre observational study was conducted in seven Italian Hospitals. Consecutive H. pylori‐positive patients who received the three‐in‐one BQT for 10 days were included in the analysis. H. pylori eradication was assessed by histology, 13C‐urea breath test, or stool antigen test. Compliance and adverse events were evaluated by interview. Results A total of 376 patients were included in the intention‐to‐treat (ITT) and 352 in the per protocol (PP) analyses. One hundred and ninety‐three subjects received probiotics supplementation. Overall, eradication rates were 90.2% (95% Confidence Interval (CI):86.7‐93.0) in ITT and 94.6% (95% CI: 91.7‐96.7) in PP analyses. The compliance was good (≥90% of treatment taken) in 94.9% of patients. The proportion of patients with a good compliance was not different with and without probiotics supplementation (94.8% vs 95.1%). Eradication rates were equally high for first‐line (91.4%), second‐line (87.5%), and third‐line treatments (91.7%) in the ITT analysis (P = .48). Adverse events were reported by 32.4% of patients, but only 6.1% of patients discontinued treatment. Conclusions The three‐in‐one BQT is highly effective and well tolerated for H. pylori eradication in daily clinical practice. Probiotics supplementation fails to improve compliance.