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Efficacy of three‐in‐one capsule bismuth quadruple therapy for Helicobacter pylori eradication in clinical practice in a multinational patient population
Author(s) -
Miehlke Stephan,
Frederking Dorothea,
Günther Thomas,
Glocker Erik,
Eisele Bianca,
Andresen Viola,
Schröder Sören,
Morgner Andrea
Publication year - 2017
Publication title -
helicobacter
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 79
eISSN - 1523-5378
pISSN - 1083-4389
DOI - 10.1111/hel.12429
Subject(s) - medicine , clarithromycin , levofloxacin , helicobacter pylori , urea breath test , omeprazole , gastroenterology , rabeprazole , population , intention to treat analysis , breath test , capsule , surgery , clinical trial , antibiotics , helicobacter pylori infection , environmental health , microbiology and biotechnology , biology , botany
Background Bismuth quadruple therapy ( BQT ) has been proven superior to standard triple therapy for Helicobacter pylori eradication in randomized clinical trials; however, little is known about the efficacy of BQT in daily routine practice. Methods In a single‐center cohort study, we analyzed consecutive H. pylori ‐positive patients in whom three‐in‐one capsule BQT (Pylera ® + omeprazole) has been prescribed. All patients were instructed in a standardized fashion, and a prospective follow‐up was planned. PCR on gastric biospies for clarithromycin and levofloxacin resistance was performed before treatment in a subgroup of patients. Treatment outcome was assessed by 13C urea breath test or by histology not earlier than 4 weeks after end of treatment. Results Three‐in‐one capsule BQT has been prescribed in 322 patients. Approximately 70.2% of patients had a migrational background. PCR results were available in 163 patients and identified resistance to clarithromycin and levofloxacin in 29 (17.8%) and 20 (12.3%) of cases, respectively. BQT was prescribed as first‐line, second‐line, and salvage treatments in 74%, 17%, and 9% of cases, respectively. Five patients discontinued treatment due to side effects (1.8%). By modified intention‐to‐treat and per‐protocol analyzes, the overall H. pylori eradication rates were 95.0% (95% CI 94.92%‐95.08%) and 96.7% (95% CI 94.6%‐98.8%), respectively. The low number of treatment failures (n = 9) did not allow to identify risk factors for failure. Conclusion Three‐in‐one capsule bismuth quadruple therapy is effective and safe for treatment of H. pylori infection in routine practice, irrespective of the patient's migrational background or the number of previous treatment failures.