Improved Helicobacter pylori Eradication Rate of Standard Triple Therapy by Adding Bismuth and Probiotic Supplement in Thai Patients

Objective: Standard triple therapy for H. pylori eradication is no longer effective in many countries including Thailand. This study was designed to evaluate the efficacy of adding bismuth and probiotic supplement to standard triple therapy for H. pylori eradication in Thai patients. Method: This prospective single-center study was conducted in Thailand. H pylori infected gastritis patients were randomized to 7day or 14-day standard triple therapy plus bismuth, with or without probiotic supplement. The treatment regimen consisted of bismuth subsalicylate (524 mg) tablets twice daily, lansoprazole (30 mg) twice daily, amoxicillin 1 g twice daily and clarithromycin MR 1 g once daily. Probiotic regimens (one serve of drinking yogurt) were composed of Bifidobacterium lactis ≥ 109 CFU/serve, Lactobacillus acidophilus ≥ 109 CFU/ serve and Lactobacillus paracasei ≥ 109 CFU/serve. The placebo was a drinking yogurt without probiotic. H. pylori infection was defined as a positive culture or two positive tests (CLO® test and histology); CYP2C19 genotyping and antibiotic susceptibility tests were carried out. H pylori eradication was evaluated by 13C-UBT 2 weeks or more after treatment. Results: 100 subjects were enrolled (25 to each of the 7day and the 14-day regimens with probiotic supplement or placebo). Antibiotic susceptibility testing showed 36.7% metronidazole resistance and 1.1% of clarithromycin resistance. CYP2C19 genotyping revealed 40.8% RM, 49% IM and 10.2% PM. The eradication rate with 7day or 14-day regimen with probiotic supplement achieved the eradication rate of 100%. Interestingly, the side effects with bitter taste in the 7day regimen with probiotic supplement was significantly less than in the 7day regimen with placebo (40% vs. 64%; p=0.04). Conclusion: 7-day standard triple therapy plus bismuth and probiotic supplement provided an excellent cure rate (100%) with fewer side effects. The efficacy of this regimen was very effective regardless of the metronidazole resistance and CYP2C19 genotype. Adding probiotic could help reduce the side effects of medications.