Single-capsule bismuth-based quadruple therapy as a rescue therapy for Helicobacter pylori eradication

Abstract

Introduction

Helicobacter pylori (H. pylori) infection is highly prevalent in Portugal and its eradication is formally recommended. However, the indiscriminate use of antimicrobials has led to a drastic rise in antibiotic resistance, with the failure of traditional eradication schemes. A single-capsule bismuth-based quadruple therapy became recently available in Portugal. This study aims to evaluate the efficacy and safety of a bismuth-based quadruple therapy as a second-line or rescue therapy.

Patients and methods

This was a multicentric study. All consecutive patients that were treated with bismuth-based quadruple therapy, as second-line or salvage treatment between July 2017 and April 2019 were enrolled. Their medical records were reviewed and clinical and laboratorial parameters, as well as data on treatment efficacy and adverse events were retrieved. Patients were also contacted by phone after treatment to confirm compliance, adverse events, and global satisfaction with this specific therapy.

Results

A total of 151 subjects were included (female—68.9%; mean age—56 ± 13.5 years). Patients were previously submitted to 212 eradication schemes (Median-1; 1–5; IQR:4): 33.5% triple clarithromycin-based, 25% sequential, 7.5% concomitant, 5.2% others, and in 28.8% it was not possible to know the previous eradication scheme(s) followed by the patient. The PPI of choice was esomeprazole (39.7%), followed by omeprazole (27.8%). Compliance was achieved in 93.4% and the overall eradication rate was 90.1% (95% CI: 84.6–94.2). Treatment-related adverse effects were experienced by 63 patients (41.7%; 95% CI: 34–49.7), being mild in 29, moderate in 19, and severe in 15. The main drawbacks of the treatment, from the patient’s perspective, were the high price (47%) and the adverse effects (16.6%). Failure to eradicate H. pylori was correlated with the following: previous rifabutin-based scheme (0 vs. 100%; p = 0.010) and a higher number of previous treatment schemes (1.5 ± 0.7 vs. 2.3 ± 1.2; p < 0.001).

Conclusion

In this South-European country a single-capsule bismuth-based quadruple therapy is an excellent option as a second-line or rescue therapy, with acceptable compliance and side effects.

Keywords:

• Helicobacter pylori
• bismuth-based quadruple therapy
• eradication rate
• Compliance
• Adverse events

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee.

Author contributions

The authors contributed equally to the writing of this paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).