Optimizing first line 7‐day standard triple therapy for Helicobacter pylori eradication: Prolonging treatment or adding bismuth: which is better?

Leow, Alex H.‐R.; Azmi, Ahmad N.; Loke, Mun‐Fai; Vadivelu, Jamuna; Graham, David Y.; Goh, Khean‐Lee

Objective: The 7‐day standard triple therapy (STT) gives unacceptablly low eradication rates of Helicobacter pylori (H. pylori). We aimed to examine whether extending STT from 7 days to 14 days or adding a bismuth compound to a 7‐day STT would result in better eradication rates. Methods: H. pylori‐positive patients were assigned to Group A (7‐day STT; rabeprazole 20 mg twice daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily, for 7 days), Group B (7‐day STT with bismuth; rabeprazole 20 mg twice daily, amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily and bismuth subcitrate 240 mg twice daily, for 7 days) and Group C (14‐day STT; rabeprazole 20 mg twice daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily for 14 days). Eradication was tested using 13C‐UBT at least 4 weeks after the completion of therapy. Results: A total of 364 patients were recruited. In the intention‐to‐treat analysis, eradication rates were 79.3% (96/121; 95% confidence interval [CI] 71.3–85.6%) for 7‐day STT, 81.7% (98/120; 95% CI 73.8–87.6%) for 7‐day STT with bismuth, and 88.6% (109/123; 95% CI 81.8–93.1%) for 14‐day STT, respectively. Statistical significance was achieved between the 7‐day and the 14‐day STT treatment (P = 0.048). Conclusions: Adding bismuth to the 7‐day STT did not result in an increase in the eradication rate. Extending the STT to 14 days, however, achieved a significantly higher eradication rate. Nevertheless, this did not achieve the targeted 90% eradication rate on intention‐to‐treat analysis.

HELICOBACTER pylori; AMOXICILLIN; CLARITHROMYCIN; METRONIDAZOLE; ANTIPARASITIC agents

Journal of Digestive Diseases, 2018, Vol 19, Issue 11, p674

1751-2972

Academic Journal

10.1111/1751-2980.12679