title: How to Effectively Use Bismuth Quadruple Therapy: The Good, the Bad, and the Ugly.
abstract: Bismuth triple therapy was the first effective Helicobacter pylori eradication therapy. The addition of a proton pump inhibitor helped overcome metronidazole resistance. Its primary indication is penicillin allergy or when clarithromycin and metronidazole resistance are both common. Resistance to the primary first-line therapy have centered on complexity and difficulties with compliance. Understanding regional differences in effectiveness remains unexplained because of the lack of studies including susceptibility testing and adherence data. We discuss regimen variations including substitutions of doxycycline, amoxicillin, and twice a day therapy and provide suggestions regarding what is needed to rationally and effectively use bismuth quadruple therapy.
authors: Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center & Baylor College of Medicine, 2002 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: dgraham@bcm.edu.
authors: David Y
authors: DY
authors: Graham
authors: Department of Internal Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro, Seoul 143-729, Korea.
authors: Sun-Young
authors: SY
authors: Lee
mesh_terms: D000863:Antacids / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001729:Bismuth / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004342:Drug Hypersensitivity; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D055118:Medication Adherence; D008795:Metronidazole / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D013752:Tetracycline / Q000627:therapeutic use
chemical_list: D000863:Antacids; D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D013752:Tetracycline; D001729:Bismuth
keywords: Adherence; Bismuth; Helicobacter pylori; Metronidazole; Proton pump inhibitors; Side effects; Tetracycline; Therapy