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Bismuth quadruple anti-H. pylori therapy is successful

A study in the latest issue of Helicobacter reports a greater than 95% success with 14-day bismuth quadruple anti-Helicobacter pylori therapy.

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A combination capsule of bismuth, metronidazole, and tetracycline plus omeprazole given as 10-day therapy has an overall effectiveness of 92–93% in per-protocol analysis with eradication of 86–91% of metronidazole-resistant Helicobacter pylori.

Dr Victor Cardenas and colleagues from Texas, USA explored whether extending the duration to 14 days would improve overall effectiveness per protocol to 95% or more in a population in which metronidazole resistance was anticipated to exist.

A one-arm, open-label pilot study of H. pylori-infected, asymptomatic/mildly dyspeptic adults, Hispanic residents of El Paso, Texas, received a 14-day course of omeprazole, plus the combination capsule.

The researchers cultured and Gram-stained specimens obtained using a minimally invasive orogastric brush.

Per-protocol effectiveness was 97%
Helicobacter

Helicobacter pylori status was determined by 13 C-urea breath test at 4 or more weeks post-therapy.
 
The team evaluated 47 subjects.

The researchers observed that per-protocol effectiveness was 97%, and 100% of metronidazole-resistant strains were eradicated.

Side effects were mild and self-limited but contributed to nonadherence.

The team noted that therapy taken for less than 10 days was more likely to result in eradication failure.

Office-based orogastric brushing was well tolerated, and positive cultures were obtained in 95%. Gram staining showed H. pylori-like forms in all specimens.
 
Dr Cardenas' team commented, "This pilot study supports the concept that 14-day OBMT therapy is likely to be more efficacious for H. pylori eradication than a 10-day course where metronidazole resistance is suspected."

"If confirmed, 14 days should be recommended in populations where metronidazole resistance is common."

Helicobacter 2012: 17(5): 382–390
10 October 2012

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