title: Quadruple therapy versus standard triple therapy for eradication of Helicobacter pylori in Kuwait.
abstract: OBJECTIVE
  Chronic infection caused by Helicobacter pylori (H. pylori) is associated with chronic gastritis, peptic ulcer disease, and gastric cancer. Eradication of H. pylori reduces morbidity of chronic gastritis and incidence of gastric cancer in high-risk population. We aimed at testing the efficacy of clarithromycin-based triple therapy and bismuth-based quadruple therapy for eradicating H. pylori in patients with chronic gastritis in Kuwait.
  
  
  METHODS
  A total of 218 dyspeptic patients from different countries who were proved to have chronic gastritis by endoscopy and gastric biopsy were enroled. All of them were naïve to H. pylori eradication therapy. They were randomised into two groups: group A, received triple therapy (omeprazole, amoxicillin, and clarithromycin) for 10days; and group B, received quadruple therapy (omeprazole, bismuth subcitrate potassium, tetracycline, and metronidazole) for 10days. All patients were tested for eradication of H. pylori by carbon-13 urea breath test 4weeks after treatment.
  
  
  RESULTS
  Total response rate of eradication therapy in both groups was 77.5% (n=169). However, group B (n=100) had a higher eradication rate (88%) than group A (n=118) (68.6%). H. pylori eradication rate was significantly higher in males (84.2%) than females (70.2%) in both groups (p<0.01). There were no differences in eradication rates with regard to median age or nationality.
  
  
  CONCLUSIONS
  Bismuth-based quadruple therapy is more effective as a first-line therapy than clarithromycin-based triple therapy for eradicating H. pylori in patients with H. pylori-related chronic gastritis in Kuwait.
authors.affiliation: Haya Al-Habeeb Gastroenterology Center, Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait; Department of Internal Medicine, Al-Azhar University, Cairo, Egypt. Electronic address: m.alboraie@gmail.com.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Alboraie
authors.affiliation: Haya Al-Habeeb Gastroenterology Center, Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.
authors.forename: Motaz
authors.initials: M
authors.lastname: Saad
authors.affiliation: Haya Al-Habeeb Gastroenterology Center, Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait; Department of Internal Medicine, Kuwait University, Kuwait City, Kuwait.
authors.forename: Jaber
authors.initials: J
authors.lastname: Al-Ali
authors.affiliation: Haya Al-Habeeb Gastroenterology Center, Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Malik
authors.affiliation: Department of Public Health and Community Medicine, Cairo University, Giza, Egypt.
authors.forename: Noha
authors.initials: N
authors.lastname: Asem
authors.affiliation: Haya Al-Habeeb Gastroenterology Center, Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.
authors.forename: Imre
authors.initials: I
authors.lastname: Schmidt
authors.affiliation: Haya Al-Habeeb Gastroenterology Center, Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Alfadhli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001944:Breath Tests; D002247:Carbon Isotopes / Q000032:analysis; D002908:Chronic Disease; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005756:Gastritis / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007730:Kuwait; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000627:therapeutic use; D011446:Prospective Studies; D013752:Tetracycline / Q000627:therapeutic use; D014508:Urea / Q000032:analysis; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D000897:Anti-Ulcer Agents; D002247:Carbon Isotopes; D009942:Organometallic Compounds; D008795:Metronidazole; D000658:Amoxicillin; D014508:Urea; D013752:Tetracycline; D017291:Clarithromycin; C002791:bismuth tripotassium dicitrate; D009853:Omeprazole