https://gastroenterology.acponline.org/archives/2023/07/28/3.htm

Less frequent dosing of bismuth quadruple therapy appears effective for H. pylori therapy

A study of Spanish patients found that single-capsule bismuth quadruple therapy administered three times a day was more effective for treating Helicobacter pylori than four times a day, with no differences in adherence or safety.


Single-capsule bismuth quadruple therapy (scBQT) may be more effective when administered three versus four times a day, according to a recent study.

Researchers used data from the European Registry on Helicobacter pylori Management to determine the effectiveness and safety of scBQT administered three times daily versus the recommended schedule of four times daily. The study included data on all Spanish adults who were registered in the Asociación Española de Gastroenterología Research Electronic Data Capture database from June 2013 to March 2021 and were receiving 10-day scBQT, along with a proton-pump inhibitor (PPI) twice daily. A multivariate analysis evaluated independent factors predicting cure. The study results were published July 19 by Gut.

Overall, 3,712 cases were included, 68% that received four daily doses and 32% that received three. The mean age was 51 years, and 63% were women. Omeprazole, 20 mg or 40 mg, and esomeprazole, 40 mg, were the PPIs most commonly used with scBQT (39%, 23%, and 33%, respectively). Cure rates were significantly better overall with the three-times-daily schedule compared with four times per day (94% [95% CI, 92.7% to 95.6%] vs. 91% [95% CI, 89.9% to 92.2%]; P=0.002), whereas data on adherence and safety were similar for both regimens. When scBQT was prescribed as a rescue therapy, cure rates were 85.5% for the four-times-daily dosage and 86% for three times daily. The multivariate analysis found that dosage three times per day, first-line therapy, use of standard or high-dose PPIs, and more than 90% adherence were significantly associated with cure.

The researchers noted that their study was not a randomized controlled trial and that data on antibiotic resistance were available in fewer than 10% of cases. They concluded that scBQT prescribed three times a day was safe and appeared to be more effective than the currently recommended schedule of four times daily. “This treatment schedule was strongly effective both as a first-line therapy and rescue therapy,” the authors wrote. “The results of this study support the use of scBQT in a four capsules three times a day schedule to eradicate H. pylori infection.” They called for their findings to be confirmed in other regions and clinical settings.