Hybrid, bismuth quadruple therapies superior to high-dose dual therapy for H pylori eradication

In the first-line treatment of Helicobacter pylori (H pylori) infection, 14-day hybrid therapy and 10-day bismuth quadruple therapy demonstrate superiority over 14-day high-dose dual therapy, reports a Taiwan study. However, high-dose therapy results in fewer adverse events than hybrid bismuth quadruple therapies.

Investigators recruited 918 adult patients with H pylori infection from nine centres in Taiwan for this multicentre, open-label, randomized trial. Participants were randomized to receive 14-day hybrid therapy, 14-day high-dose dual therapy, or 10-day bismuth quadruple therapy between 1 August 2018 and December 2021.

The ¹³C-urea breath test was used to determine eradication status. The eradication rate of H pylori assessed in the intention-to-treat population served as the primary outcome.

The intention-to-treat eradication rates were as follows: 91.5 percent (95 percent confidence interval [CI], 88.4‒94.6) for 14-day hybrid therapy, 83.3 percent (95 percent CI, 87.8‒95.0) for 14-day high-dose dual therapy, and 90.2 percent (95 percent CI, 87.8‒95.0) for 10-day bismuth quadruple therapy.

Hybrid therapy (difference, 8.2 percent, 95 percent CI, 4.5‒11.9; p=0.002) and bismuth quadruple therapy (difference, 6.9, 95 percent CI, 1.6‒12.2; p=0.012) were comparable with each other and more effective than high-dose dual therapy.

In terms of adverse events, 10-day bismuth quadruple therapy had the highest rate at 32 percent, followed by 14-day hybrid therapy at 27 percent and 14-day high-dose dual therapy at 13 percent. Notably, patients on high-dose dual therapy reported the fewest adverse events (p<0.001 for both).