Addition of bismuth to standard triple therapy for Helicobacter pylori eradication: a randomised controlled trial

Asim, Muhammad; Baqai, Khurram; Abbas, Zaigham; Laique, Nasir; Samejo, Shoukat Ali

doi:10.5455/jpma.55396

Cited by 1 publication

(2 citation statements)

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“…Earlier it had been suggested that the high pH associated with vonoprazan might reduce the effectiveness of bismuth 5 but apparently that is not the case and adding bismuth may be alternative approach to improving H. pylori eradication rates. [26][27][28]32,33 In conclusion, a higher dosage of vonoprazan, or the addition of bismuth may be required to achieve high H. pylori eradication rates in some regions. Larger studies are needed to confirm and extend these finding and resolve the issues regarding an optimal timing to administer the antibiotics and the dose of vonoprazan.…”

Section: Discussionmentioning

confidence: 99%

“…We also found an improvement in outcome with the addition of bismuth which is considered to be additive. Earlier it had been suggested that the high pH associated with vonoprazan might reduce the effectiveness of bismuth 5 but apparently that is not the case and adding bismuth may be alternative approach to improving H. pylori eradication rates 26–28,32,33 …”

Section: Discussionmentioning

confidence: 99%

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Pilot studies of vonoprazan‐containing Helicobacter pylori eradication therapy suggest Thailand may be more similar to the US than Japan

Ratana‐Amornpin,

Sanglutong,

Eiamsitrakoon

et al. 2023

Helicobacter

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BackgroundVonoprazan‐containing Helicobacter pylori eradication is reliably effective in Japan. Its effectiveness in other countries remains unclear. Here, we examined vonoprazan‐H. pylori therapies in Thailand.Materials and MethodsThis was pilot study of four different vonoprazan containing therapies. Subjects were randomized to: 14‐day dual therapy (500 mg amoxicillin q.i.d. plus 20 mg vonoprazan b.i.d.), 14‐day triple therapy (amoxicillin 1 g b.i.d., slow release clarithromycin‐MR, 1 g daily plus vonoprazan 20 mg b.i.d.), 7‐day high‐dose vonoprazan triple therapy (amoxicillin 1 g b.i.d., clarithromycin‐MR 1 g daily and 60 mg vonoprazan once daily), and 14‐day vonoprazan triple therapy plus bismuth (amoxicillin 1 g b.i.d., clarithromycin‐MR 1 g daily, vonoprazan 20 mg b.i.d., and bismuth subsalicylate 1048 mg b.i.d.). Eradication was confirmed 4 weeks after therapy. Antimicrobial susceptibility and CYP3A4/5 genotyping were performed.ResultsOne hundred H. pylori‐infected patients (mean age 54.3 ± 13 years, 51% men) were randomized. All were CYP3A4 extensive metabolizers. Cure rates with both 14‐day vonoprazan dual therapy and 14‐day triple therapy were low: 66.7%; 95% CI = 43–85% (14/21), and 59.3%; 95% CI = 39–78%) (16/27), respectively. In contrast, 7‐day high‐dose vonoprazan triple therapy and 14‐day vonoprazan triple plus bismuth proved effective 92.3%; 95% CI = 75%–99% (24/26) and 96.2%; 95% CI = 80%–100% (25/26), respectively.ConclusionBoth 14‐day vonoprazan dual and triple therapy were ineffective for H. pylori eradication in Thailand. Higher dosage of vonoprazan, and/or the addition of bismuth may be required to achieve high H. pylori eradication rates. High‐dose vonoprazan triple therapy and vonoprazan triple therapy adding bismuth might be used as first‐line treatments in some regions with high efficacy irrespective of CYP3A4/5 genotype and clarithromycin resistance.

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