title: Comparison of bismuth-containing quadruple and concomitant therapies as a first-line treatment option for Helicobacter pylori.
abstract: OBJECTIVE
  Helicobacter pylori eradication rates with standard triple regimens are worsening, and alternative treatments are urgently needed in some populations. The present study aimed to compare the efficacy of bismuth-based quadruple and concomitant regimens.
  
  
  METHODS
  Consecutive Helicobacter pylori-positive patients with non-ulcer dyspepsia were randomized to receive one of two regimens: (i) bismuth subsalicylate 300 mg q.i.d., esomeprazole 40 mg b.i.d., tetracycline 500 mg q.i.d., and amoxicillin 1 g b.i.d. (bismuth group) or (ii) esomeprazole 40 mg b.i.d., tetracycline 500 mg q.i.d., amoxicillin 1 g b.i.d., and metronidazole 500 mg t.i.d. (concomitant group) for 14 days. Gastroscopy and 14C-urea breath test were performed before enrollment, and urea breath test was repeated six weeks after the treatment.
  
  
  RESULTS
  A total of 200 patients were randomized, and 180 of them completed the protocols. The intention-to-treat and per-protocol eradication rates were 79% (95% confidence interval 71-87) and 89.7% (95% confidence interval 83-95) in the bismuth group and 74% (95% confidence interval 68-81) and 80.4% (95% confidence interval 72-87) in the concomitant group. The bismuth regimen achieved a slightly better eradication rate compared to the concomitant group in both per-protocol and intention-to-treat analysis, but results were not statistically significant (p>0.05). Ten patients (6 in bismuth, 4 in concomitant groups) dropped out of the study because of side effects.
  
  
  CONCLUSIONS
  The quadruple regimens with or without bismuth achieved moderate eradication rates as a first-line eradication option of Helicobacter pylori in our population, in which a bismuth-based regimen seems more appropriate. The compliance and side effects are important issues affecting the success of these regimens.
authors.affiliation: University of Gaziantep, Faculty of Medicine Division of Gastroenterology, Gaziantep, Turkey. kadayifci@gantep.edu.tr.
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Kadayifci
authors.forename: Ahmet
authors.initials: A
authors.lastname: Uygun
authors.forename: Zülfikar
authors.initials: Z
authors.lastname: Polat
authors.forename: Murat
authors.initials: M
authors.lastname: Kantarcioğlu
authors.forename: Güldem
authors.initials: G
authors.lastname: Kılcıler
authors.forename: Omer
authors.initials: O
authors.lastname: Başer
authors.forename: Ayhan
authors.initials: A
authors.lastname: Ozcan
authors.forename: Ozdeş
authors.initials: O
authors.lastname: Emer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D000930:Antidiarrheals / Q000627:therapeutic use*; D001729:Bismuth / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D064098:Esomeprazole / Q000627:therapeutic use; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use*; D011446:Prospective Studies; D012459:Salicylates / Q000627:therapeutic use*; D013752:Tetracycline / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000897:Anti-Ulcer Agents; D000930:Antidiarrheals; D009942:Organometallic Compounds; D012459:Salicylates; D008795:Metronidazole; C015715:bismuth subsalicylate; D000658:Amoxicillin; D013752:Tetracycline; D064098:Esomeprazole; D001729:Bismuth