Optimizing first line 7‐day standard triple therapy for Helicobacter pylori eradication: Prolonging treatment or adding bismuth: which is better?

Objective The 7‐day standard triple therapy (STT) gives unacceptablly low eradication rates of Helicobacter pylori ( H. pylori ). We aimed to examine whether extending STT from 7 days to 14 days or adding a bismuth compound to a 7‐day STT would result in better eradication rates. Methods H. pylori ‐positive patients were assigned to Group A (7‐day STT; rabeprazole 20 mg twice daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily, for 7 days), Group B (7‐day STT with bismuth; rabeprazole 20 mg twice daily, amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily and bismuth subcitrate 240 mg twice daily, for 7 days) and Group C (14‐day STT; rabeprazole 20 mg twice daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily for 14 days). Eradication was tested using 13 C‐UBT at least 4 weeks after the completion of therapy. Results A total of 364 patients were recruited. In the intention‐to‐treat analysis, eradication rates were 79.3% (96/121; 95% confidence interval [CI] 71.3–85.6%) for 7‐day STT, 81.7% (98/120; 95% CI 73.8–87.6%) for 7‐day STT with bismuth, and 88.6% (109/123; 95% CI 81.8–93.1%) for 14‐day STT, respectively. Statistical significance was achieved between the 7‐day and the 14‐day STT treatment ( P  = 0.048). Conclusions Adding bismuth to the 7‐day STT did not result in an increase in the eradication rate. Extending the STT to 14 days, however, achieved a significantly higher eradication rate. Nevertheless, this did not achieve the targeted 90% eradication rate on intention‐to‐treat analysis.