Efficacy of a Modified Sequential Therapy Including Bismuth Subcitrate as First-Line Therapy to Eradicate Helicobacter pylori in a Turkish Population

Background Eradication rates of Helicobacter pylori with standard triple therapy are not satisfactory. Sequential therapy is an alternative method to overcome this problem. Objectives The aim of this study was to assess efficacy of a modified sequential therapy with the addition of a bismuth prepara...

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Published in:Helicobacter (Cambridge, Mass.) Mass.), 2012-12, Vol.17 (6), p.486-490
Main Authors: Uygun, Ahmet, OZEL, A. Melih, Sivri, Bulent, Polat, Zulfikar, Genç, Halil, Sakin, Yusuf Serdar, Çelebi, Gürkan, Uygur-Bayramiçli, Oya, Erçin, Cemal Nuri, Kadayifçi, Abdurrahman, Emer, Ozdes, Gunal, Armagan, Bagci, Sait
Format: Article
Language:English
Subjects:
Adult
Age
Amoxicillin
Anti-Bacterial Agents - administration & dosage
Anti-Bacterial Agents - adverse effects
bismuth
Breath Tests
Diarrhea
Drug Therapy, Combination - adverse effects
Drug Therapy, Combination - methods
Female
Fever
Hand
Helicobacter Infections - drug therapy
Helicobacter pylori
Humans
Infection
Male
Metronidazole
Middle Aged
modified treatment
Nausea
Organometallic Compounds - administration & dosage
Organometallic Compounds - adverse effects
Pain
Prospective Studies
sequential therapy
Sex
Side effects
Tablets
Tetracyclines
Treatment Outcome
Turkey
Urea
Urea - analysis
Vagina
Vomiting
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Summary:Background Eradication rates of Helicobacter pylori with standard triple therapy are not satisfactory. Sequential therapy is an alternative method to overcome this problem. Objectives The aim of this study was to assess efficacy of a modified sequential therapy with the addition of a bismuth preparation, as first‐line treatment in the eradication of H. pylori infection. Materials and Methods One hundred and forty‐two H. pylori‐positive patients were included in the study. Patients were given a 14‐day sequential therapy program consisting of pantoprazole, 40 mg (b.i.d. for 14 days); colloidal bismuth subcitrate, 300 mg 4 (two tablets before breakfast and dinner, for 14 days); amoxicillin, 1 g (b.i.d.for the first 7 days); tetracycline, 500 mg (q.i.d. for the second 7 days); and metronidazole, 500 mg (t.i.d. for the second 7 days). Eradication was tested by urea breath test (UBT) 6 weeks after completion of treatment. Results Of the 142 patients included, 131 completed the study. “Per‐protocol” and “intention‐to‐treat” analyses revealed high eradication rates in this group (92.0–95% CI, 87.2–96.8%, and 81.0–95% CI, 74.5–87.4%, respectively). There was no relation to sex and age with this modified sequential therapy. Compliance was satisfactory (11 patients – four women and seven men were unavailable for follow‐up), and side effects were minimal (six patients had to stop treatment – metronidazole‐related facial swelling and numbness on the face and hands in two patients; tetracycline‐related fever and epigastric pain and nausea and vomiting in two patients; and amoxicillin‐related diarrhea and vaginal discharge in two patients). These side effects were reversible and resolved after the cessation of the related medication. Conclusions This 14‐day modified sequential treatment, including bismuth, achieves a significantly high eradication rates in patients with H. pylori infection, with five satisfactory patient compliance and minor side effects.
ISSN:1083-4389
1523-5378
DOI:10.1111/j.1523-5378.2012.00989.x