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Sequential therapy more effective than quad therapy for H. pylori
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Research published in BMC Gastroenterology suggests 10-day sequential therapy — as opposed to 14-day modified bismuth quadruple therapy — appears more effective in treating Helicobacter pylori bacteria. Also, since neither therapy reached a 90% elimination rate, more studies on these two therapies are needed.
“The classical bismuth quadruple therapy, which consists of a [proton pump inhibitor], bismuth, tetracycline and metronidazole, is frequently used as a first- or second-line regimen. However, it is known that more than 30% of patients stop taking their medicine due to the complicated regimen and the high rate of adverse events,” Ju Yup Lee, MD, of the department of internal medicine at Seoul National University Bundang Hospital, Korea, and colleagues wrote. “In view of antibiotic resistance, a modified bismuth quadruple therapy (PBAT), in which metronidazole is replaced with amoxicillin, is very attractive because many studies have reported that H. pylori resistance to amoxicillin and tetracycline is low and furthermore, amoxicillin is easier to take in comparison to metronidazole.”
Lee and colleagues studied 390 patients aged 18 years and older with H. pylori. Half received sequential therapy (SQT), which consisted of 40 mg pantoprazole plus 1 g amoxicillin twice a day for 5 days, then 40 mg pantoprazole and 500 mg clarithromycin twice a day and 500 mg metronidazole three times a day for 5 days. The other half received PBAT, which consisted of 40 mg pantoprazole, 600 mg bismuth subcitrate, 1 g tetracycline, and 1 g amoxicillin, twice a day. A 13C-urea breath test, rapid urease testing, or histology was performed 4 to 6 weeks later to check for eradication. Lee and colleagues reported the intention-to-treat (ITT) elimination rates of SQT was 74.6% and its per-protocol (PP) rate was 84.2%. PBAT’s ITT elimination rate was 68.7% and its PP rate was 76.5%. Neither ITT nor PP analyses had a significant difference, and 90.3% of the patients on SQT completed the therapy, compared with 90.8% in the PBAT group.
According to researchers, adverse events were lower in the modified PBAT group vs. the SQT group (36.9% vs. 47.7%, P = .04). The most common side effects for patients on PBAT were epigastric pain and diarrhea; patients on SQT reported abdominal bloating and misleading tastes.
“Our prospective, multi-center, randomized, open-label, parallel design clinical trial demonstrated that SQT for 10 days appears more effective than PBAT in spite of frequent adverse events,” Lee and colleagues wrote. “However, both 10-day SQT and 14-day PBAT did not achieve excellent eradication rates [of greater than] 90%. Thus, additional trials are necessary to identify a more satisfactory first-line eradication therapy for H. pylori. – by Janel Miller
Disclosure: Healio.com/Hepatology was unable to determine relevant financial disclosures at the time of publication.
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