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We aimed to compare the success rate, adverse drug events, and cost-effectiveness of tailored  Helicobacter pylori  eradication and modified bismuth-containing quadruple therapy. The diagnosis of  H. pylori  infection was randomly based on either rapid urease test (RUT) or dual priming oligonucleotide (DPO)-based multiplex polymerase chain reaction (PCR) in 1:1 ratio. According to the presence of point mutations that cause clarithromycin resistance, patients in the tailored therapy (TT) group received standard triple therapy or classic bismuth quadruple therapy. Patients with positive RUT results received 40 mg pantoprazole, 1000 mg amoxicillin, 750 mg metronidazole, and 600 mg bismuth subcitrate twice daily for 14 days (PAM-B therapy). Between the TT (n = 141) and PAM-B groups (n = 141),  H. pylori  eradication rate did not differ significantly according to intention-to-treat (TT: 80.9% vs. PAM-B: 85.8%,  P  = 0.262), modified intention-to-treat (TT: 89.1% vs. PAM-B: 91.0%,  P  = 0.606), and per-protocol (TT: 89.0% vs. PAM-B: 93.5%,  P  = 0.198) analyses. The average cost for successful eradication was higher in the TT group than in the PAM-B group ($340.7 vs. $263.9 per patient). PAM-B therapy exhibits similar efficacy and improved cost-effectiveness compared to TT based on the results of DPO-PCR tests. www.clinicaltrials.gov  identifier is NCT05002595

Comparison of tailored Helicobacter pylori eradication versus modified bismuth quadruple therapy in Korea: a randomized controlled trial