What is bismuth-based 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

Bismuth-based therapy is an alternative first-line therapy (in areas with high clarithromycin and metronidazole resistance, and in patients with prior macrolide exposure or penicillin-allergic) [4, 2]  or second-line therapy (see below). [3] It consists of the following:

  1. PPI or H2 receptor antagonist (eg, lansoprazole 30 mg BID [11] or ranitidine 150 mg BID [5] plus

  2. Bismuth subsalicylate 525 mg QID [5]  (or bismuth tripotassium dicitrate 300 mg QID [11] plus

  3. Metronidazole 250 mg QID [5]  or 500 mg TID [11]  (or levofloxacin) [29] plus

  4. Tetracycline 500 mg QID [5]

Duration is 10-14 days. [2, 5, 30, 11]  The eradication rate was 90.4% for 10 days of bismuth quadruple therapy, while extending therapy to 14 days achieved an eradication rate of 97.1% [30]


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