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

• Main Authors: Guang-Hong Jheng, I-Chen Wu, Hsiang-Yao Shih, Meng-Chieh Wu, Fu-Chen Kuo, Huang-Ming Hu, Chung-Jung Liu, Wen-Hung Hsu, Chi-Tan Hu, Ming-Jong Bair, Chao-Hung Kuo, Deng-Chyang Wu, Ping-I Hsu
• Format: Article
• Language: English
• Published: Hindawi Limited 2015-01-01
• Series: BioMed Research International
• Online Access: http://dx.doi.org/10.1155/2015/163960
• ISSN: 2314-6133; 2314-6141

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.