efficacy of clarithromycin containing bismuth–based regimen as a second-line therapy in helicobacter pylori eradication

background: the eradication of helicobacter pylori infection, commonly prevailing in the stomach, has been important since its introduction. adequate preparations should be made in finding alternatives when faced with first-line treatment failures. currently, ideal second-line treatments are indistinct and varied among countries as result of different antibiotic resistance patterns. we aimed to evaluate the safety and efficacy of a clarithromycin-containing bismuth-based quadruple regimen as a second-line treatment. methods: forty-eight h. pylori -positive patients with proven gastric or duodenal ulcers and/or erosions who had previously failed to respond to furazolidone-containing regimens were enrolled. they received pantoprazole (40 mg-bid), amoxicillin (1 g-bid), bismuth subcitrate (240 mg-bid), and clarithromycin (500mg-bid) for 10 days. eight weeks after treatment, a 14 c-urea breath test was performed for the re-evaluation of h. pylori eradication. results: forty-three patients completed the study. h.pylori eradication rates were 79.2% (95% ci=65.00-89.53) and 88.4% (95% ci=74.91-96.11) according to intention-to-treat and per-protocol analyses, respectively. all patients had excellent compliance to treatment and one did not continue therapy because of adverse effects. conclusion: in developing countries such as iran, a ten-day clarithromycin-containing bismuth-based quadruple regimen is encouraged as a second-line treatment because of the acceptable rate of eradication and low adverse effects.