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Adding bismuth to triple therapy boosts H. pylori eradication

Source/Disclosures Source: McNicholl AG, et al. Clin Gastroenterol Hepatol. 2019:1016/j.cgh.2019.03.048. ADD TOPIC TO EMAIL ALERTS Receive an email when new articles are posted on . Please provide your email address to receive an email when new articles are posted on Subscribe ADDED TO EMAIL ALERTS You've successfully added to your alerts. You will receive an email when new content is published.



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Recently published data showed that adding bismuth salts to a triple therapy of proton pump inhibitors, amoxicillin and clarithromycin helped eradicate Helicobacter pylori infection.

Javier P. Gisbert, MD, PhD, of the gastroenterology unit at Hospital Universitario de La Princesa in Spain, and colleagues wrote that the treatment regimen for patients with H. pylori infection remains largely undefined and can be difficult due to drug resistances.

“Bismuth is one of the few antimicrobials to which resistance is not developed,” they wrote in Clinical Gastroenterology and Hepatology. “In addition, bismuth has an additive or synergistic effect with several antibiotics that is independent of clarithromycin and/or metronidazole resistances. Thus, combining bismuth and clarithromycin in the same regimen may be a promising option, as has been tested in previous literature.”

Researchers performed an interim analysis of data from the European Registry on H. pylori Management, a prospective trial registry of clinical data and outcomes from patients in 27 European counties since 2013. They identified 1,141 treatment-naive patients who received a first-line therapy of bismuth salts (240 mg) in addition to a triple therapy of proton pump inhibitors, amoxicillin and clarithromycin.

In their intention to treat analysis, investigators found the eradication rate among these patients was 88% compared to 94% in per-protocol. However, when patients received 14 days of treatment, intention to treat eradication increased to 93%.

Compliance with treatment (OR = 13; 95% CI, 5.3–32), a double dose of PPI (OR = 4.7; 95% CI, 1.8–12) and 14 days of treatment (OR = 2; 95% CI, 1.3–3.2) were all associated with higher eradication rates.

“Bismuth co-administrated with antibiotics against H. pylori can have an additive or synergistic effect on antibiotics and, consequently, improve the efficacy of eradication treatment,” Gisbert and colleagues wrote. “Our study shows that, especially in patients without antibiotic susceptibility testing, the combination of bismuth plus a standard clarithromycin-containing triple therapy, especially if given for 14 days and with high-dose PPI, is an effective and safe empirical strategy in countries with intermediate to high clarithromycin resistance rates.” – by Alex Young

Disclosures: Gisbert reports serving as a speaker, consultant and advisory member for and/or receiving research funding from Allergan, Almirall, AstraZeneca, Casen Recordati and Nycomed. Please see the full study for all other authors’ relevant financial disclosures.