The bacterium Helicobacter pylori is associated with benign and malignant diseases of the upper gastrointestinal tract, and increasing antibiotic resistance has made alternative treatments necessary. In a study published Online First by The Lancet, researchers show that 10 days of quadruple therapy with omeprazole plus a single three-in-one capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline (quadruple therapy) is better than the standard 7 day treatment regimen of omeprazole, amoxicillin, and clarithromycin in adults with H pylori infection. The Article is by Prof Peter Malfertheiner, Otto-von-Guericke-Universtitat, Magdeburg, Germany, and colleagues.
Infection with Helicobacter pylori is a substantial public health problem that affects 20-50% of people in industrialised nations and up to 80% in less-developed countries. The infection is associated with many disorders, including peptic ulcer disease, and gastric cancer.
The researchers found that, in the worst case scenario, eradication rates using the above regimens were 80% (174 of 218 participants) in the quadruple therapy group versus 55% (123 of 222) in the standard therapy group. Safety profiles for both treatments were similar; main adverse events were gastrointestinal and central nervous system disorders.
The authors say: “Data from our study corroborate the safety and tolerability of bismuth in Europe and highlight the effect of antibiotic resistance on eradication efficacy between combination treatments. Clarithromycin-resistant H pylori continues to increase in prevalence, and although rates of metronidazole resistance are also high, the results from our study showed that clarithromycin resistance reduces the efficacy of standard therapy, whereas resistance to metronidazole has a slight effect on the efficacy of quadruple therapy.”
They conclude: “In regions with high levels of clarithromycin resistance, treatment with quadruple therapy should be considered as first-line therapy for H pylori eradication.”
In a linked Comment, Dr Byoung Hwan Lee and Dr Nayoung Kim, Seoul National University College of Medicine, South Korea, discuss differing results from previous studies and conclude: “Further prospective study is necessary to compare bismuth-containing quadruple therapy with the non-bismuth modalities as first-line therapy, not only for eradication rate but also for compliance and side-effects, to establish the most efficient modality to eradicate H pylori.”
SourceThe Lancet