Add bismuth salts to triple therapy for eradication of Helicobacter pylori infection

DELHI: Combination of bismuth salts and triple therapy of proton pump inhibitors (PPIs), amoxicillin and clarithromycin helped in the eradication of Helicobacter pylori infection in more than 90% of the infected patients in a recent study published in the journal Clinical Gastroenterology and Hepatology.

A 14-day standard triple therapy with clarithromycin and amoxicillin has a poor eradication rate. The addition of bismuth salts has been proposed for first-line eradication of Helicobacter pylori. Javier P. Gisbert, of the gastroenterology unit at Hospital Universitario de La Princesa in Spain, and colleagues conducted the study to determine the effectiveness and safety of the combination of bismuth and the standard, clarithromycin-containing triple therapy in eradication of H pylori infection, using data from a large multi-centre registry.

For the purpose, the researchers performed an interim analysis of data from the European Registry on H. pylori Management, a prospective trial registry of clinical data and outcomes from patients in 27 European counties since 2013. They identified 1,141 treatment-naive patients who received the first-line therapy of bismuth salts (240 mg) in addition to triple therapy of proton pump inhibitors, amoxicillin, and clarithromycin.

Also Read: How Helicobacter pylori causes gastric cancer

Key findings of the study include:

• Intention to treat and per-protocol rates of eradication were 88% and 94%, respectively.


• Intention to treat eradication increased to 93% in patients who received 14-day treatments.


• Adverse events occurred in 36% of patients; 76% of these events were mild, with a mean duration of 6 days. In multivariate analysis, eradication was associated with treatment compliance, a double dose (equivalent to 40 mg omeprazole) of proton pump inhibitor, and 14-day duration of treatment.

Also Read: Scientists synthesize new compound to fight stomach infections

“Bismuth co-administrated with antibiotics against H. pylori can have an additive or synergistic effect on antibiotics and, consequently, improve the efficacy of eradication treatment,” wrote the authors.

“Our study shows that, especially in patients without antibiotic susceptibility testing, the combination of bismuth plus a standard clarithromycin-containing triple therapy, especially if given for 14 days and with high-dose PPI, is an effective and safe empirical strategy in countries with intermediate to high clarithromycin resistance rates,” they concluded.

For detailed research log on to https://www.cghjournal.org/article/S1542-3565(19)30369-6/fulltext