Bismuth‐based quadruple therapy for Helicobacter pylori— a single triple capsule plus lansoprazole

Abstract

INTRODUCTIONHelicobacter pylori infection of the gastric mucosa is causally related to peptic ulcer disease and cure of this infection has therefore become the treatment goal in ulcer patients. 1±5 Several guidelines suggest that patients with non-ulcer dyspepsia should also be treated for the infection and a serological based`test and treat' strategy for young dyspeptics is gaining popularity. 3,4 Even though the indications for treatment are expanding, no consensus exists as to the most optimal therapy. Physicians and drug companies tried to identify a single antibiotic to cure the infection. The hope of ®nding such a`golden' or`magic bullet', however, has diminished over the years and presently physicians have to choose from a wide range of 14-day dual and 7±10-day triple or quadruple therapies.2, 5±8 Physicians seem to prefer the simpler regimens.Fourteen day bismuth-based triple therapy is the oldest effective and most widely investigated anti-Helicobacter therapy.2, 5±9 Treatment duration can be shortened to 7 days if a proton pump inhibitor is added (quadruple therapy). 8±10 This regimen has produced one of the highest cure rates.11±21 Patients, however, have to take many pills per day and the regimen is perceived as complex. Fear of non-compliance has delayed its global acceptance. SUMMARY Background:Recently a new`all in one' single capsule with the three components of bismuth-based triple therapy became available in trials for treating Helicobacter pylori. Aim: To investigate the ef®cacy and tolerability of this new capsule when combined with lansoprazole. Methods: A total of 66 consecutive infected patients from a single centre received two single triple capsules four times daily and lansoprazole 30 mg b.d. for 7 days. Each capsule contained 60 mg of bismuth subcitrate, 125 mg of tetracycline and 125 mg of metronidazole. Endoscopy with biopsies for CLO-test, histology and culture from antrum and corpus was performed before and at least 5 weeks after treatment.

Advantages of Moxifloxacin and Levofloxacin-based triple therapy for second-line treatments of persistent Helicobacter pylori infection: a meta analysis

“…It has been reported that quadruple therapy consisting of a similar combination of antibiotics and a proton-pump inhibitor has repeatedly been shown to be equally eff ective in spite of the presence of metronidazole resistance when the attention was given to the dose of metronidazole (e.g. 400 or 500 mg three times daily) and duration of therapy of approximately 14 days [47][48][49][50][51][52]. So, metronidazole-containing quadruple therapy may have overcome metronidazole resistance to some degree in our studies.…”

Efficacy and safety of single‐triple capsules of bismuth biskalcitrate, metronidazole and tetracycline, given with omeprazole, for the eradication of Helicobacter pylori: an international multicentre study

“…This regimen was selected for development based on effectiveness, treatment duration, patient convenience, safety and cost. [16][17][18][19][20] The 'three-in-one' feature of this capsule was designed to increase acceptability and compliance, as the patient would need to take three of the four medications from the same bottle at the same times. This study was designed to assess the efficacy and safety of this regimen for the eradication of H. pylori.…”

Treatment of H. pylori Infection: A Review

“…In the last years, however, the decrease of eradication rate of the standard triple therapy based on amoxicillin, clarithromycin plus a PPI, and the increasing prevalence of metronidazole or clarithromycin resistant strains have induced several authors to propose the quadruple therapy -based on metronidazole, tetracycline Fig (7), bismuth compounds and a PPI or ranitidine-even as first line option [76][77][78][79][80][81][82][83][84][85][86][87][88][89]. In literature several protocols are reported, decribing treatments lasting 7, 10 or 14 days, with different dosages of metronidazole, bismuth, tetracycline and PPI.…”