Adjunctive bismuth yields high H. pylori eradication rates
Adding bismuth to a 14-day course of standard triple therapy with clarithromycin and amoxicillin leads to a high rate of Helicobacter pylori infection eradication, with an acceptable safety profile and level of adherence, according to a study.
Researchers performed an interim analysis of data from the European Registry on H pylori Management. The analysis included 1,141 treatment-naïve patients who received first-line treatment with bismuth salts 240 mg plus a proton pump inhibitor (57 percent received esomeprazole, 18 percent omeprazole, 11 percent pantoprazole and 14 percent rabeprazole), amoxicillin 1 g and clarithromycin 500 mg, all administered twice daily.
Eradication rates were 88 percent in the intention-to-treat analysis and 94 percent in the per-protocol analysis. The intention-to-treat eradication rate notably increased to 93 percent in patients who received 14-day treatments.
Adverse events occurred in 36 percent of patients. Majority (76 percent) of the reported events were mild, with a mean duration of 6 days.
Multivariate models revealed eradication to be associated with treatment compliance (odds ratio [OR], 13.0), use of a double dose of proton pump inhibitor (equivalent to 40-mg omeprazole; OR, 4.7) and 14-day duration of treatment (OR, 2.0).
According to researchers, the addition of bismuth salts has been proposed for first-line eradication of H. pylori infection due to the poor eradication rates of standard triple therapy. The present data show that such a strategy yields high eradication rates.