The Efficacy of Bismuth based Quadruple and Sequential Therapies in Helicobacter pylori Eradication

Objective: New therapy regimens are needed for Helicobacter pylori H. pylori) eradication because of increased resistance to the commonly used antibiotics. This study aimed to compare the efficacy of bismuth quadruple therapy versus sequential therapy for H. pylori eradication. Materials and Methods: Patients who presented with dyspepsia complaints and were diagnosed with H. pylori infection by histopathologic examination of biopsies obtained by gastroscopy were evaluated retrospectively. Two hundred and five patients who received bismuth-based quadruple therapy and sequential therapy for H. pylori eradication were included in the study. Bismuth-based quadruple therapy group were given pantoprazole 2x40 mg, bismuth subcitrate 4x300 mg, amoxicillin 2x1000 mg and metronidazole 3x500 mg for 14 days. In the bismuth-based sequential therapy group, the protocol was as follows; pantoprazole 2x40 mg (14 days), bismuth subcitrate 4x300 mg (14 days), amoxicillin 2x1000 mg (first 7 days), metronidazole 3x500 mg (second 7 days) and levofloxacin 1x500 mg (second 7 days). Eradication was determined by stool H. pylori Antigen test six weeks after the treatment. Results: A total of 102 patients in group 1 and 91 patients in group 2 completed the treatment and there was no significant difference between the two groups (p=0.310). H. pylori eradication rate showed no significant difference between the two groups (p=0.093), while group 1 attained a better eradication rate than group 2 on intention-to-treat, which was statistically significant (p=0.033). Conclusion: We achieved better eradication rates with bismuth-based quadruple therapy compared to the sequential therapy. We recommend bismuth-based quadruple regimen as the first-line eradication therapy to avoid drug incompatabilities seen during the sequential regime.