Efficacy of bismuth‐based quadruple therapy for eradication of Helicobacter pylori infection based on previous antibiotic exposure: A large‐scale prospective, single‐center clinical trial in China

Abstract

Objective This study aims to evaluate the efficacy and safety of three bismuth‐based quadruple regimens for eradication of Helicobacter pylori (H pylori) infection in a large number of H pylori‐positive patients with or without previous eradication therapy. Methods Consecutive adult patients with H pylori infection, regardless of previous eradication therapy, were eligible for the present study. Three bismuth‐based quadruple regimens were selected according to the past history of antibiotics use: (A) esomeprazole, amoxicillin, clarithromycin, and colloidal bismuth tartrate; (B) esomeprazole, amoxicillin, furazolidone, and colloidal bismuth tartrate; and (C) esomeprazole, doxycycline, furazolidone, and colloidal bismuth tartrate. All patients received a 14‐day course of treatment, and 13C/14C urea breath test was utilized at four weeks after the completion of treatment to determine the H pylori eradication. Then, the eradication rates were calculated in terms of intention‐to‐treat (ITT) and per‐protocol (PP) analyses. Adverse events (AEs) were recorded during the treatment. Results Overall, 1,226 patients were recruited, and 331, 57, and 838 patients were allocated to receive regimens A, B, and C, respectively. The H pylori eradication rates were 84.0%, 82.5%, and 82.9% (ITT) and 94.6%, 92.2%, and 93.7% (PP), respectively, in regimens A, B, and C. However, there was no significant difference among these three regimens. The incidence of AEs was 4.6% for all patients during the study, that is, 3.3%, 10.5%, and 4.7% for regimens A, B, and C, respectively. All AEs were mild and recovered at the follow‐up visit. Conclusion All three bismuth‐based quadruple regimens based on the previous antibiotic use can achieve satisfactory eradication rates for H pylori infection and are safe.

Doxycycline and minocycline inHelicobacter pyloritreatment: A systematic review and meta‐analysis

“…The total number of participants was 5240. Twenty‐three studies included a total of 83 arms, including 14 single arms 19,33‐36 and 69 double arms 5,12,14‐16,18,19,24‐32,37‐39 . Among the 83 arms, 66 arms 5,12,14,16,18,24‐30,33,34,37‐39 received doxycycline, and 17 arms 15,19,31,32,35,36 received minocycline.…”

“…Twenty-three studies included a total of 83 arms, including 14 single arms 19,[33][34][35][36] and 69 double arms. 5,12,[14][15][16]18,19,[24][25][26][27][28][29][30][31][32][37][38][39] Among the 83 arms, 66 arms 5,12,14,16,18,[24][25][26][27][28][29][30]33,34,[37][38][39] received doxycycline, and 17 arms 15,19,31,32,35,36 received minocycline.…”

“…Forty-one arms received quadruple therapy with doxycycline . 5,14,16,[25][26][27][28][29][30]33,34 Among them, 23 arms 5,14,16,[25][26][27]34 therapy. Twelve studies 5,14,16,25,26,[28][29][30]33,34 performed both ITT and PP analyses, while one study 27 performed only PP analysis.…”

“…5,14,16,[25][26][27][28][29][30]33,34 Among them, 23 arms 5,14,16,[25][26][27]34 therapy. Twelve studies 5,14,16,25,26,[28][29][30]33,34 performed both ITT and PP analyses, while one study 27 performed only PP analysis. In terms of the development level of the countries, 10 arms 14,25,28,29 were from developed countries, and 31 arms 5,16,26,27,30,33,34 were from developed countries.…”

“…13 Some recent studies indicated that semisynthetic tetracycline regimens had a satisfactory effect on H. pylori infection, not only as a component of first-line treatment but also as a component of second-line treatment. [14][15][16][17] Therefore, semisynthetic tetracyclines are possible alternatives for the treatment of H. pylori infection considering increasing antibiotic resistance.…”