Comparative study of Helicobacter pylori eradication rates of concomitant therapy vs modified quadruple therapy comprising proton-pump inhibitor, bismuth, amoxicillin, and metronidazole in Korea
- Authors
- Choe, Jung Wan; Jung, Sung Woo; Kim, Seung Young; Hyun, Jong Jin; Jung, Young Kul; Koo, Ja Seol; Yim, Hyung Joon; Lee, Sang Woo
- Issue Date
- 4월-2018
- Publisher
- WILEY
- Keywords
- bismuth salts; concomitant therapy; eradication; Helicobacter pylori
- Citation
- HELICOBACTER, v.23, no.2
- Indexed
- SCIE
SCOPUS
- Journal Title
- HELICOBACTER
- Volume
- 23
- Number
- 2
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/76234
- DOI
- 10.1111/hel.12466
- ISSN
- 1083-4389
- Abstract
- BackgroundThe standard triple Helicobacter pylori regimen now shows unacceptably low treatment success in Korea. Administration of the concomitant therapy for 10days, which has a high cure rate, is recommended as an alternative first-line treatment in areas of high clarithromycin resistance including Korea. Recently, modified bismuth-containing quadruple therapy with amoxicillin (PAM-B therapy) showed excellent results, regardless of dual clarithromycin and metronidazole resistance. This study compared the concomitant therapy with PAM-B therapy as a first-line treatment for H.pylori infection. MethodSubjects infected with H.pylori and naive to treatment were performed a head-to-head comparison between 10-day concomitant therapy [rabeprazole 20mg, amoxicillin 1g, clarithromycin 500mg, and metronidazole 500mg twice daily] and 14-day PAM-B therapy [rabeprazole 20mg, amoxicillin 1g, metronidazole 750mg, and tripotassium dicitrato bismuthate 600mg (elemental bismuth 240mg) twice daily]. Six weeks after treatment, H.pylori eradication was assessed. ResultsTwo hundred and seventy subjects were randomized. Both regimens achieved high cure rates: 83.0% (112/135) and 88.1% (119/135) by the intention-to-treat analysis and 95.5% (106/111) and 96.6% (114/118) by the per-protocol analysis, respectively. The intention-to-treat and per-protocol analyses revealed no statistically significant difference in the eradication rate (P=.299 and P=.743, respectively). Rates of adverse events were similar between groups (25.2% vs 23.0%, P -value: .776) Adverse events, which resulted in poor compliance, occurred in six patients of each group, but there were no serious complications. ConclusionsPAM-B therapy is as effective as concomitant therapy for eradicating H.pylori with comparative safety. PAM-B therapy is regarded as a promising alternative to standard triple therapy for a first-line eradication in Korea.
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