Zinc carnosine-based modified bismuth quadruple therapy vs standard triple therapy for Helicobacter pylori eradication: A randomized controlled study

Abstract

BACKGROUND Helicobacter pylori ( H. pylori ) infection is a worldwide problem with increasing burden on the health sector due to its increasing rate of resistance. The conventional triple therapy (TT) is becoming obsolete with a high failure rate of eradication, necessitating the need for better alternatives or regimens. AIM To investigate H. pylori eradication rate of TT vs modified bismuth quadruple therapy. METHODS Ninety-two patients with dyspepsia symptoms and positive 13 C-urea breath test were randomly assigned to two groups. The first group (control group) was treated for 14 d using standard TT protocol: Esomeprazole (40 mg twice daily), amoxicillin (1 g twice daily) and clarithromycin (500 mg twice daily). On the other hand, the second group was prescribed a 10-d course of modified bismuth quadruple therapy fortified with zinc carnosine: TT in addition to bismuth subcitrate (240 mg twice daily) and zinc carnosine (75 mg twice daily). A repeated 13 C-urea breath test was done 4 wk after the completion of the eradication therapy. RESULTS Among the 92 subjects, 67.4% were males and 32.6% were females. There were no differences in demographic characteristics (age, body mass index, smoking history, previous antibiotics use and ethnicity) between the modified bismuth quadruple therapy group and TT group. The eradication rate was higher [93.5% (43/46)] in the modified bismuth quadruple therapy group compared to 69.6% (32/46) in the standard TT group ( P = 0.003). Of the tested predictor variables, only nationality, smoking and therapy type were statistically significant. Besides dizziness, which was recorded in modified bismuth quadruple therapy group, there were no significant differences in side effects between the two groups. CONCLUSION Ten days of modified bismuth quadruple therapy fortified with zinc carnosine is superior to 14 d of conventional TT in eradicating H. pylori infection, with no additional significant adverse events.

Efficacy and Safety of Polaprezinc-Based Therapy versus the Standard Triple Therapy for Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Accordingly, PZN regimen can be effectively used for H. pylori with an ITT H. pylori eradication rate of 80.4%. Moreover, in a recent RCT, PZN was adjunctly used with the bismuth quadruple therapy achieving an H. pylori eradication rate of 93.5%, which was statistically significant in comparison with the triple therapy [ 24 ].…”

“…Moreover, polaprezinc (PZN), a zinc-L-carnosine complex ( Figure 1 ) [ 23 ], has promising properties as an antioxidant promoting ulcer healing and mucosal protective agent to counteract various clinical conditions in animals and human studies [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. Furthermore, PZN can function by ameliorating inflammation [ 33 ], preventing apoptosis [ 34 ], and protecting tight junctions.…”

A review for non-antibiotic treatment of Helicobacter pylori: new insight

“…Polaprezinc (PZN) or zinc carnosine (L-carnosine) are zinc chelate compounds that protect the digestive mucosa ( Mahmoud et al, 2022 ). This antioxidant compound is particularly efficient in protecting against H. pylori and promoting ulcer healing, and unlike other antibiotics, it does not cause drug resistance ( Teng et al, 2020 ; Ibrahim et al, 2022 ; Mahmoud et al, 2022 ). PZN has been shown in several trials to be useful in reducing apoptosis and inflammation, healing skin and stomach wounds, and preserving tight junctions ( Furihata et al, 2020 ; Ibrahim et al, 2022 ).…”

The Therapeutic Potential of Carnosine as an Antidote against Drug-Induced Cardiotoxicity and Neurotoxicity: Focus on Nrf2 Pathway

“…A very recent randomized controlled study that was carried out by Ibrahim and collaborators demonstrated that 10 days of modified bismuth quadruple therapy fortified with polaprezinc (also known as zinc carnosine) was more effective than 14 days of conventional triple therapy in eradicating H. pylori infection, without additional significant adverse events [ 257 ]. Of note, a different recent study employing polaprezinc-loaded antioxidant electrospun membrane demonstrated the ability of this formulation to up-regulate the Nrf2/HO-1/SOD-1 signaling molecules in a concentration-dependent manner [ 258 ].…”