Bismuth-Containing Quadruple Therapy is Superior to Sequential Treatment for the Eradication of Helicobacter Pylori: Results of a Comparative Study in Daily Practice

摘要

Purpose: The purpose of the study was to compare, in routine practice, the standard sequential treatment (proton pump inhibitor [PPI] + amoxicillin followed by clarithromy-cin-metronidazole) to a bismuth-containing quadruple therapy (omeprazole + bismuth-tetracycline-metronidazole) in non-selected patients suffering from an infection due to H. pylori. Patients and methods: Thirty-seven patients receiving the sequential treatment were compared to 43 patients receiving the quadruple therapy. The primary objective was the eradication rates of H. pylori. The secondary objectives were to analyze the resistance to antibiotics and the occurrence of adverse events. Results: In the intent-to-treat analysis, the obtained eradication rates with quadruple therapy and sequential treatment were respectively of 86% and 67.6% (p=0.048), and of 90.2% and 71.4% in the per-protocol analysis (p=0.035). With the sequential treatment, the treatment failures were related to a resistance to clarithromycin and/or metronida-zole in 66.7% of cases, and, with the quadruple therapy, in 75% of cases to a resistance to metronidazole. No adverse events were related to the use of bismuth. Conclusions: In this French study that was performed in routine practice, the bismuth-containing quadruple therapy showed a statistically significant superiority compared to the sequential treatment. These results lead to consider the bismuth-containing quadruple therapy as the first-intent treatment of infections due to H. pylori.