High-dose dual therapy versus bismuth-containing quadruple therapy for the treatment of Helicobacter pylori infection – A review of the strengths, weaknesses, and proposed solutions

Abstract

A BSTRACT Helicobacter pylori is the principal cause of peptic ulcers, gastric cancer, and mucosa-associated lymphoid tissue lymphoma. The first treatment to H. pylori infection is dual therapy (a bismuth compound plus metronidazole). On the launch of omeprazole in 1988, dual therapy became omeprazole and amoxicillin (low dose). The poor H. pylori eradication rates by either bismuth-based or low-dose dual therapy drove more combinations of antibiotics were needed. Antibiotic resistance, especially clarithromycin and metronidazole, has made bismuth-containing quadruple therapy (BCQT) a savior for first-line and second-line treatments. However, its complicated dosing regimen commonly causes more adverse events and poor drug compliance. Thus, high-dose dual therapy (HDDT) has been re-arising. This article reviews the strengths and weaknesses of HDDT versus BCQT with proposed solutions.

High-dose dual therapy versus bismuth-containing quadruple therapy for Helicobacter pylori eradication: a systematic review and meta-analysis with trial sequential analysis

“…7 Although the eradication rate has improved, BQT still has some limitations: not available in some regions, complicated dosing regimen, more adverse events, poor drug compliance, and high cost. 8,9 Therefore, it is urgent to discover and identify novel regimens with high efficacy, less use of antibiotics, and fewer adverse events to eradicate H. pylori .…”

Vonoprazan‐amoxicillin dual therapy versus bismuth‐containing quadruple therapy for Helicobacter pylori eradication: A systematic review and meta‐analysis

“…Hence, several international guidelines and consensuses 3,5,8,9 recommend bismuth‐containing quadruple therapy (BQT) as a first‐line therapy in regions with high clarithromycin resistance. Nevertheless, the BQT has some limitations, such as its complicated regimen because of multiple drugs, heightened risks of adverse events, poor adherence, and high cost 10‐12 . Therefore, uncovering regimens that are more convenient, necessitate fewer antibiotics, and have fewer adverse events is of great practical significance.…”

“…Nevertheless, the BQT has some limitations, such as its complicated regimen because of multiple drugs, heightened risks of adverse events, poor adherence, and high cost. [10][11][12] Therefore, uncovering regimens that are more convenient, necessitate fewer antibiotics, and have fewer adverse events is of great practical significance.…”

High‐dose dual therapy versus bismuth‐containing quadruple therapy for the eradication of Helicobacter pylori: A systematic review and meta‐analysis

“…Regarding drugs for H. pylori eradication, vonoprazan, as a component of HDDT, may be a new treatment option though optimizing the dual therapy for each region is still required. 23,45 Sensitivity analysis revealed that the study by Hsu et al 19 was the main source of heterogeneity in the eradication rate of H. pylori. Two studies conducted in Taiwan Province, China showed high eradication rates of >90% with HDDT.…”