ABSTRACT
Background and study aims: Standard sequential treatment for Helicobacter pylori [H. pylori] eradication has less success because of increasing clarithromycin resistance. Extended treatment and bismuth containing regimens were, therefore, investigated
Patients and methods: Consecutive H. pylori-positive patients with dyspepsia were randomly allocated to one of the three sequential regimens: The first group was given lansoprazole 30 mg b.i.d. plus amoxicillin 1 g b.i.d. for the first 5 days, followed by lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., and metronidazole 500 mg t.i.d. for the second 5 days [standard sequential, SS]. The second group was given the same regimen but for 7 + 7 days instead of 5 + 5 days [extended sequential, ES]. In the third group, colloidal bismuth 600 mg b.i.d. was added to the second regimen for 14 days [extended sequential + bismuth subcitrate, ES + B]. Urea breath test or histology was performed before enrolment and 6 weeks after the end of treatment to detect H. pylori
Results: A total of 280 patients were included in the study. Per-protocol eradication rates were 62% [56/90], 72% [56/78], and 75% [54/72] in patients who received SS, ES, and ES + B regimens, respectively. Moreover, intention-to-treat eradication rates were 53% [56/104], 62% [56/90] and 62% [54/86], respectively. The differences in eradication rates between the groups were not statistically significant
Conclusion: Although prolonging of the sequential treatment to 14 days may be considered, addition of bismuth to the regimen is of no avail