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Modified bismuth quadruple therapy with low‐dose metronidazole as first‐line therapy for Helicobacter pylori infection
Author(s) -
Pih Gyu Young,
Choi Kee Don,
Gong Eun Jeong,
Na Hee Kyong,
Ahn Ji Yong,
Lee Jeong Hoon,
Jung Kee Wook,
Kim Do Hoon,
Song Ho June,
Lee Gin Hyug,
Jung HwoonYong
Publication year - 2021
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.12759
Subject(s) - metronidazole , helicobacter pylori , medicine , regimen , gastroenterology , amoxicillin , urea breath test , clarithromycin , breath test , nausea , adverse effect , antibiotics , helicobacter pylori infection , microbiology and biotechnology , biology
Abstract Background Bismuth‐containing quadruple therapy is an effective alternative first‐line therapy for Helicobacter pylori infection. We evaluated the efficacy and safety of a modified twice‐a‐day bismuth quadruple regimen (BQT‐2) with low‐dose (1000 mg total) metronidazole as first‐line therapy for the eradication of H pylori . Materials and Methods In this prospective pilot study, patients diagnosed with H pylori infection and naïve to eradication therapy were included. The modified BQT‐2 therapy consisted of rabeprazole 20 mg, amoxicillin 1 g, metronidazole 500 mg, and tripotassium dicitrato bismuthate 600 mg (elemental bismuth 240 mg) twice daily, given 30 minutes before morning and evening meals for 14 days. H pylori eradication was assessed by 13 C‐urea breath test conducted at least 4 weeks after therapy completion. Results In 66 patients who received the modified BQT‐2 regimen, the compliance rate was 100% and the H pylori eradication rate was 77.3%. H pylori was successfully cultured in 50 (75.8%) patients. The resistance rates to metronidazole and clarithromycin were 30.0% and 22.0%, respectively. Eradication rates were not significantly different according to the resistance to metronidazole (metronidazole‐susceptible: 74.3% [26/35], metronidazole‐resistant: 73.3% [11/15]; P > .99). Most of the adverse events were mild, with 20 (30%) patients developing nausea, epigastric soreness, loose stool, asthenia, skin rash, dizziness, taste perversion, headache, or dyspepsia. Conclusions Twice‐a‐day modified BQT‐2 regimen with low‐dose metronidazole was suboptimal as an alternative first‐line therapy for eradicating H pylori , despite high patient compliance.