Bismuth-Based Quadruple Therapy as First-Line Treatment for Clarithromycin-Resistant <i>Helicobacter pylori</i> Infection: A Prospective Randomized Comparison of 7- and 14-Day Treatment Regimens

BackgroundThe optimal duration of regimens for tailored therapy based on genotypic resistance for clarithromycin has yet to be established.AimThis study was a nationwide, multicenter, randomized trial comparing empirical therapy with tailored therapy based on genotypic resistance for first‐line eradication of Helicobacter pylori. We also compared the eradication rates of 7‐ and 14‐day regimens for each group.Patients and MethodsPatients with H. pylori infection were first randomized to receive empirical or tailored therapy. Patients in each group were further randomized into 7‐ or 14‐day regimens. Empirical therapy consisted of a triple therapy (TT) regimen (twice‐daily doses of pantoprazole 40 mg, amoxicillin 1 g, and clarithromycin 500 mg) for 7 or 14 days. Tailored therapy consisted of TT of 7 or 14 days in patients without genotypic resistance. Patients with genotypic resistance were treated with bismuth quadruple therapy (BQT) regimens (twice‐daily doses of pantoprazole 40 mg, three daily doses of metronidazole 500 mg, and four times daily doses of bismuth 300 mg and tetracycline 500 mg) for 7 or 14 days. A 13C‐urea breath test assessed eradication rates. The primary outcome was eradication rates of each group.ResultsA total of 593 patients were included in the study. The eradication rates were 65.7% (201/306) in the empirical therapy group and 81.9% (235/287) in the tailored therapy group for intention‐to‐treat analysis (p < 0.001). In the per‐protocol analysis, the eradication rates of the empirical therapy and tailored groups were 70.3% (201/286) and 85.5% (235/274) (p < 0.001), respectively. There was no difference in compliance between the two groups. The rate of adverse events was higher in the tailored group compared to the empirical group (p < 0.001).DiscussionOur study confirmed that tailored therapy based on genotypic resistance was more effective than empirical therapy for H. pylori eradication in Korea. However, no significant difference was found between 7‐ and 14‐day regimens for each group. Future studies are needed to determine the optimal duration of therapy for empirical and tailored therapy regimens.

Empirical Therapy Versus Tailored Therapy of Helicobacter pylori in Korea: Results of the K‐CREATE Study

Kim,

Kim

et al. 2024

Optimal Duration of Bismuth‐Containing Quadruple Therapy for Helicobacter pylori Eradication: A Systematic Review and Meta‐Analysis

Duan,

Kong,

Wang

et al. 2024

BackgroundThe eradication of Helicobacter pylori (H. pylori) is crucial due to its rising prevalence and increasing resistance. Bismuth‐containing quadruple therapies (BcQTs) have been proposed as a viable treatment option; however, the optimal duration for it remains contentious. This systematic review and meta‐analysis aimed to compare the clinical efficacy of short‐term BcQT (defined as 7 or 10 days) with a standard 14‐day course.MethodsA systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted for randomized controlled trials published in English until June 20, 2024. Eligibility criteria were applied to identify relevant studies. Summary risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for the included studies regarding eradication rates, adverse effects, and compliance. This systematic review and meta‐analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement and was previously registered in PROSPERO under registration number CRD42024547773.ResultsThis meta‐analysis finally included 15 trials involving a total of 4505 patients. The eradication rates for short courses of BcQT were lower than those for the 14‐day course (RR 0.96, 95% CI 0.93–0.99). However, the eradication rate for the 10‐day therapy was comparable to that of the 14‐day therapy (RR 0.98, 95% CI 0.95–1.00). Subgroup analyses of antibiotic combinations indicated that tetracycline and metronidazole combinations yielded similar H. pylori eradication rates in the 7‐day versus the 14‐day BcQT (RR 0.93, 95% CI 0.84–1.02). In the potassium‐competitive acid blocker subgroup, the eradication rates remained similar across the 14‐day group and the short‐course treatment groups, whether evaluating the short‐term treatment groups as a whole or the 7‐ and 10‐day subgroups separately. Additionally, the adverse effects and compliance associated with the short course of BcQT were comparable to those of the 14‐day therapy.ConclusionA 10‐day course of BcQT may represent the optimal treatment duration. Nevertheless, the choice of antibiotic combination should be guided by the regional antibiotic resistance patterns of H. pylori, as combinations with lower resistance rates are more effective.Trial RegistrationPROSPERO number: CRD42024547773

Nationwide Trends in Helicobacter pylori Eradication Therapies in Korea: Impact of Guideline Updates on Treatment Practices

Jung,

Kim,

Park

2024

IntroductionHelicobacter pylori infects over 50% of the global population, prompting the issuance of guidelines for effective diagnosis and treatment. However, research on guideline dissemination and adherence is limited. Therefore, we assessed the nationwide status of H. pylori eradication therapies in Korea before and after guideline updates.MethodsUsing data from the Korean National Health Insurance Service, this retrospective cohort study analyzed changes in H. pylori eradication therapies across three periods: Phase I (2006–2007), Phase II (2014–2015), and Phase III (2021–2022). It examined therapy regimens, confirmation tests, and retreatment rates.ResultsAmong 1,657,746 patients included, the number undergoing eradication therapy increased across the phases (Phase I: 234,365; Phase II: 493,889; Phase III: 929,492). The use of conventional triple therapy declined from 96.1% in Phase I to 88.3% in Phase III, while non‐bismuth and bismuth quadruple therapies increased to 6.8% and 3.3%, respectively, in Phase III. The proportion of patients following a 1‐week regimen of conventional triple therapy decreased from 90.3% in Phase I to 54.2% in Phase III, while a 2‐week regimen increased to 36.1% in Phase III. Confirmation testing within 1 year of therapy increased from 21.3% in Phase I to 43.0% in Phase III, whereas retreatment rates increased from 3.8% in Phase I to 8.8% in Phase III.ConclusionsGuideline updates have influenced H. pylori eradication practices in Korea, leading to increased use of quadruple therapies with longer treatment durations. However, further improvements in confirmatory tests and retreatment following failed initial therapy are required.