Quadruple Therapy for Helicobacter pylori Infection

David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Disclosures

Journal Watch 

In This Article

Abstract and Introduction

Abstract

A combination of bismuth subcitrate potassium, metronidazole, tetracycline, and omeprazole was safe and effective at eradicating H. pylori infection.

Introduction

Eradication of Helicobacter pylori infection requires multiple-drug therapy. Given that some of the standard drugs, particularly clarithromycin, lose efficacy because of increasing antibiotic resistance, evaluation of new therapeutic regimens is essential.

To test a new four-drug regimen, European investigators conducted an industry-sponsored, noninferiority, open-label, randomized phase III trial involving 438 patients with H. pylori infection and upper gastrointestinal symptoms. Patients received either quadruple therapy (a single capsule containing bismuth subcitrate potassium, metronidazole and tetracycline, 4 times a day, plus omeprazole twice daily) for 10 days or standard therapy (omeprazole, amoxicillin and clarithromycin twice daily) for 7 days. Successful eradication of H. pylori infection was defined as negative urea breath tests at ≥28 and ≥56 days after completion of therapy.

The intent-to-treat eradication rate was higher in the quadruple-therapy group than in the standard-therapy group (80% vs. 55%; P<0.0001). Safety profiles were similar in both groups. Treatment failures in the standard-therapy group were associated with clarithromycin resistance (P<0.0001).

The authors conclude that 10-day quadruple therapy provides higher eradication rates and a similar safety profile compared with 7-day standard therapy in a European population. They further suggest that, because of the rising incidence of clarithromycin resistance, quadruple therapy should be considered as first-line therapy for H. pylori infection.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....