First-Line Treatment in the Eradication of Helicobacter Pylori: where are we now?

Aim: Helicobacter pylori (HP) are the most common human infectious agent worldwide. Approximately half of the patients remain infected after ‘eradication’ treatment with the triple regimen of a proton pump inhibitor (PPI), amoxicillin (AMO), and clarithromycin (CLA). In this study, this PPI-based triple regimen was compared to a quadruple regimen, including bismuth citrate (BC), a PPI, metronidazole (MET), and tetracycline (TET), and BPMT. Methods: Total 215 patients who were treated with lansoprozole (LAN), AMO and CLA (LAC); and another 210 patients who were treated with BPMT for 14 days for the purpose of HP eradication between January 2011 and April 2014 were included in this study. The treatment period was 14 days for both groups. Results: Demographic characteristics and endoscopic findings were similar in both groups. The HP eradication rate was % 53.4 in the LAC group, and it was %78.5 in the BPMT group (P< 0.05). The rates of non-compliance with treatment and side effects were higher in the BPMT group (P< 0.05). Among all, 55 patients in the LAC group and 110 patients in the BPMT group were reported to have had difficulties conforming to the treatment (P = 0.020). In the questionnaire on the side effects of the drugs, 30 patients in the LAC group and 90 in the BPMT group gave positive answers (P = 0.006). The most frequently reported side effects were dry mouth and metallic taste. The eradication rates were % 53.4 in the LAC regimen, and %78.5 in the BPMT regimen. This difference was statistically significant (P = 0.026). Conclusion: The efficacy of LAC for HP eradication in Turkey has diminished due to high microbial resistance to antibiotics. The BPMT regimen should be considered a first-line treatment because of its higher eradication rate. We suggest that BPMT could be accepted as a firstline treatment for acute HP infection. LAC is an alternative treatment for a select group of patients.