Quadruple of Bismuth, Pantoprazole, Amoxicillin, and Metronidazole for the First-Line Helicobacter pylori Eradication Therapy

Introduction: To determine the Helicobacter pylori (H. pylori) eradication rates with a quadruple treatment regimen consisted of pantoprazole, bismuth subcitrate, metronidazole, and amoxicillin for 14 days in a country with high metronidazole and clarithromycin resistance rates.
Methods: All patients were prescribed 14-day quadruple therapy (pantoprazole 40 mg twice daily, bismuth subcitrate 600 mg 2 × 1, amoxicillin 1 g twice daily, and Metronidazole 500 mg three times a day, for 14 days). The success rates of eradication treatment were investigated with stool H. pylori antigen test performed 2 months after eradication.
Results: Among 132 H. pylori -infected treatment-naive patients, 8 (6.0%) patients could not complete the study due to adverse events or lost from the follow up. Among 124 patients who completed the study, 10 patients presented with a positive result on stool H. pylori antigen testing at 8th week, while in remaining 114 cases, the test result was negative. In intention to treat analysis, the eradication rate was determined as 86.4% (95% confidence interval [CI]=81.2%–92.3%), while in per-protocol analysis, the eradication rate was 91.9% (95% CI=88.2%–96.1%).
Discussion and Conclusion: With low adverse events and high compliance rates, this treatment modality should be kept in mind for H. pylori eradication especially in regions with high clarithromycin resistance.

Keywords: Amoxicillin; Bismuth subcitrate; Helicobacter pylori eradication; Metronidazole