What is novel concomitant nonbismuth quadruple therapy for the eradication of Helicobacter pylori infection?

Updated: Dec 09, 2020
  • Author: Joseph Adrian L Buensalido, MD; more...
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Answer

Answer

Novel concomitant therapy consists of the following [27] :

  1. PPI (eg, rabeprazole 20 mg TID) for 10 days plus

  2. Amoxicillin 1 g TID for 10 days (or, if penicillin allergic, bismuth subcitrate 240 mg QID for 10 days) plus

  3. Rifabutin 150 mg BID for 10 days plus

  4. Ciprofloxacin 500 mg BID for 10 days

The regimen with amoxicillin eradicated H  pylori in 95.2% of cases, while the one with bismuth subcitrate achieved an eradication rate of 94.2%.

An alternative concomitant therapy regimen consists of the following three agents given every 8 hours for 14 days [28] :

  1. Amoxicillin 3 g plus
  2. Omeprazole 120 mg plus
  3. Rifabutin 150 mg

This regimen is available as Talicia. In a double-blind, randomized trial, the eradication rate with this regimen was 83.8%. The trial excluded persons of Asian descent because of the higher prevalence of poor cytochrome P450 2C19 metabolizers in this population. [28]


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