Quadruple therapy is still the most effective for Helicobacter pylori, but triple therapy with a proton-pump inhibitor (PPI), amoxicillin, and clarithromycin is about as effective, according to the results of a randomized trial published in the December issue of Gastroenterology. However, bismuth-based triple therapy for longer than 14 days should no longer be considered.
“One-week PPI triple therapy is well tolerated and effective,” write Peter H. Katelaris, from the University of Sydney in Australia, and colleagues. “The addition of PPI to bismuth triple therapy allows reduction of treatment duration with improved efficacy and tolerability, despite a high rate of metronidazole resistance.”
In the QUADRATE study, infected dyspeptic patients received seven days of treatment twice daily with pantoprazole 40 mg, amoxicillin 1000 mg, and clarithromycin 500 mg (PAC7); or seven days of treatment with pantoprazole 40 mg twice daily, bismuth subcitrate 108 mg, and tetracycline 500 mg, both four times daily, and metronidazole 200 mg three times daily and 400 mg at night (PBTM7); or 14 days of treatment with bismuth subcitrate 108 mg and tetracycline 500 mg, both four times daily, and metronidazole 200 mg three times daily and 400 mg at night (BTM14).
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