Bismuth supplements as the first‐line regimen for <i>Helicobacter pylori </i>eradication therapy: Systemic review and meta‐analysis

Ko, Soon Young; Kim, Yeon-Ji; Chung, Woo Chul; Lee, Seung Jae

doi:10.1111/hel.12565

Cited by 66 publications

(63 citation statements)

References 49 publications

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“…Many studies have shown that among different combinations of bismuth-based quadruple therapy, the success rate can exceed 90%. [28][29][30] Ko et al 31 also showed that when the studies were performed in a high clarithromycin-resistant area (≥15%) or included patients with clarithromycin resistance, bismuth-containing regimens were superior to non-bismuth regimens. The advantage of bismuth quadruple therapy was that its efficacy was not affected by antibiotic resistance, while dual resistance to CLA and MET >15% impaired the efficacy of all non-BQTs.…”

Section: F I G U R E 2 Cyp2c19 Polymorphism Detected In Patients a mentioning

confidence: 99%

Comparison of four different regimens against Helicobacter pylori as a first‐line treatment: A prospective, cross‐sectional, comparative, open trial in Chinese children

et al. 2020

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Backgrounds Due to the decreasing eradication rate of Helicobacter pylori, some novel alternatives have been developed, such as bismuth‐containing quadruple therapy and non‐bismuth‐containing quadruple therapy (sequential and concomitant treatment). Little is known about whether a success rate above 90% can be achieved with these regimens in Chinese children. Methods In this prospective, open, comparative cross‐sectional study, we recruited treatment‐naïve children (aged between 6 and 18 years) with H pylori infection. The patients were assigned either standard triple therapy, sequential therapy, bismuth‐based quadruple therapy, or concomitant therapy at the discretion of the prescribing physician. H pylori infection was evaluated at least 4 weeks after the completion of the treatment. A negative urea breath test (UBT) indicated successful eradication. The primary endpoint was the eradication frequency of H pylori in the full analysis set (FAS), which included all children who received at least one dose of the treatment and with available follow‐up data. Results Between September 2017 and December 2018, 228 patients were finally included in the FAS analyses. The eradication rates were 74.1% for standard triple therapy (43/58, [95% CI: 62.8%‐85.5%]), 69.5% for sequential therapy (41/59, [95% CI: 57.8%‐81.2%]), 89.8% for bismuth‐based quadruple therapy (53/59, [95% CI: 82.1%‐97.5%]), and 84.6% for concomitant therapy (44/52, [95% CI: 74.8%‐94.4%]). Bismuth‐based therapy was superior to triple therapy, while sequential therapy and concomitant therapy were not superior to triple therapy. The frequency of adverse events was 12.1% (7/58) in standard triple therapy, 6.8% (4/59) in sequential therapy, 15.3% (9/59) in bismuth‐based therapy, and 15.4% (8/52) in concomitant therapy. The rate of adverse events was similar among the four groups. Conclusion Bismuth quadruple therapy can achieve an eradication rate of 89.8% as first‐line treatment and is safe and well tolerated. Bismuth could be a promising alternative as a first‐line regimen in Chinese children.

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Section: F I G U R E 2 Cyp2c19 Polymorphism Detected In Patients a mentioning

confidence: 99%

Comparison of four different regimens against Helicobacter pylori as a first‐line treatment: A prospective, cross‐sectional, comparative, open trial in Chinese children

et al. 2020

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“…Bismuth-containing quadruple therapy exhibits a high eradication rate, even in the presence of antibiotic resistance. 3 Although resistance rate to metronidazole is over 30% in Korea, bismuth-containing quadruple therapy is effective unless the minimum inhibitory concentration (MIC) of metronidazole exceeds 32 μg/mL. 4 Furthermore, H. pylori resistance against tetracycline has been low and stable in Korea for the past 16 years.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of twice a day, bismuth‐containing quadruple therapy using high‐dose tetracycline and metronidazole for second‐line Helicobacter pylori eradication

et al. 2020

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Background/Aims Conventional second‐line, bismuth‐containing quadruple therapy is administered four times a day. We aimed to evaluate the efficacy and safety of twice a day administration compared to the four times a day therapy. Methods Medical records of consecutive patients with positive 13C‐urea breath tests (UBTs) after first‐line eradication were reviewed. From December 2018 to June 2019, 100 consecutive 13C‐UBT‐positive patients received tetracycline 1 g, metronidazole 750 mg, bismuth subcitrate 300 mg, and pantoprazole 20 mg twice a day for one week. The same number of consecutive13C‐UBT‐positive patients before December 2018 was included as controls. The control group received tetracycline 500 mg and bismuth subcitrate 300 mg four times a day, metronidazole 500 mg three times a day, and pantoprazole 20 mg twice a day for one week. Eradication was confirmed based on a 13C‐UBT performed in the 5th week after taking quadruple therapy. Results Ninety‐eight patients from the twice a day group and 99 patients from the four times a day group were analyzed. The eradication rate did not differ between the twice a day group (92/98, 93.9%) and the four times a day group (92/99, 92.9%). Adverse drug effects were found in 36 patients from the twice a day group and 50 patients from the four times a day group (P = .051). Abdominal pain, discomfort, and distention were more common with four times a day intake (13.1%) than with twice a day intake (4.1%; P = .024). Conclusions We determined for the first time that twice a day intake of bismuth‐containing quadruple therapy using 2 g/d of tetracycline, 1.5 g/d of metronidazole, and 600 mg/d of bismuth subcitrate for one week is effective and safe as the conventional four times a day therapy. Twice a day intake decreased abdominal pain, discomfort, and distention.

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“…Addition of bismuth to clarithromycin based triple therapy has been shown to increase the eradication rate. 38 One can consider addition of bismuth to triple therapy but more data are needed to establish its incremental value in Singapore.…”

Section: Challenges and Future Strategiesmentioning

confidence: 99%

Helicobacter pylori Treatment Strategies in Singapore

Ang

2021

Gut and Liver

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The management of Helicobacter pylori infection in Singapore remains a clinical challenge. Similar to other regions, there has been an increase in antibiotic resistance rates through the years. Nonetheless, over the past two decades, clarithromycin-based triple therapy has continued to be used as the first line treatment option, with an eradication rate exceeding 90%, although the accepted treatment duration must now be lengthened from 1 to 2 weeks to maintain efficacy. Concomitant and sequential therapies did not demonstrate superiority over standard triple therapy. Current empiric second line treatment utilizes either bismuth-based quadruple therapy or levofloxacin-based triple therapy, but outcomes remain less than ideal. Identifying options to further improve treatment success rates is challenging. Strategies being considered include the use of potent acid suppressants, such as vonoprazan, and H. pylori culture and antibiotic susceptibility testing-guided therapy.

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Bismuth supplements as the first‐line regimen for Helicobacter pylori eradication therapy: Systemic review and meta‐analysis

Cited by 66 publications

References 49 publications

Comparison of four different regimens against Helicobacter pylori as a first‐line treatment: A prospective, cross‐sectional, comparative, open trial in Chinese children

Comparison of four different regimens against Helicobacter pylori as a first‐line treatment: A prospective, cross‐sectional, comparative, open trial in Chinese children

Efficacy and safety of twice a day, bismuth‐containing quadruple therapy using high‐dose tetracycline and metronidazole for second‐line Helicobacter pylori eradication

Helicobacter pylori Treatment Strategies in Singapore

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