Comparison of Second-Line Quadruple Therapies with or without Bismuth for Helicobacter pylori Infection

Abstract EN

The bismuth-based quadruple regimen has been applied in Helicobacter pylori rescue therapy worldwide.

The non-bismuth-based quadruple therapy or “concomitant therapy” is an alternative option in first-line eradication but has not been used in second-line therapy.

Discovering a valid regimen for rescue therapy in bismuth-unavailable countries is important.

We conducted a randomized controlled trial to compare the efficacies of the standard quadruple therapy and a modified concomitant regimen.

One hundred and twenty-four patients were randomly assigned into two groups: RBTM (rabeprozole 20 mg bid., bismuth subcitrate 120 mg qid, tetracycline 500 mg qid, and metronidazole 250 mg qid) and RATM (rabeprozole 20 mg bid., amoxicillin 1 g bid., tetracycline 500 mg qid, and metronidazole 250 mg qid) for 10 days.

The eradication rate of the RBTM and RATM regimen was 92.1% and 90.2%, respectively, in intention-to-treat analysis.

Patients in both groups had good compliance (~96%).

The overall incidence of adverse events was higher in the RATM group (42.6% versus 22.2%, P = 0.02 ), but only seven patients (11.5%) experienced grades 2-3 events.

In conclusion, both regimens had good efficacy, compliance, and acceptable side effects.

The 10-day RATM treatment could be an alternative rescue therapy in bismuth-unavailable countries.