Korean J Gastroenterol.  2019 Jan;73(1):26-34. 10.4166/kjg.2019.73.1.26.

Effect of 7-day Bismuth Quadruple Therapy versus 14-day Moxifloxacin Triple Therapy for Second-line Helicobacter pylori Eradication Therapy

Affiliations
  • 1Department of Internal Medicine, Kosin University College of Medicine, Korea. mipark@kosinmed.or.kr
  • 2Department of Internal Medicine, Dong-eui Medical Center, Busan, Korea.

Abstract

BACKGROUND/AIMS
Both bismuth-containing quadruple therapy and moxifloxacin-containing triple therapy have been suggested as second-line eradication therapy for Helicobacter pylori (H. pylori) infection. We aimed to evaluate the efficacy of 14-day moxifloxacin-containing triple therapy (14-EAM) in second-line H. pylori eradication in comparison to 7-day bismuth-containing quadruple therapy (7-RBMT).
METHODS
From January 2011 to December 2015, a total of 569 patients who failed to respond to first-line triple therapy and who subsequently received second-line 7-RBMT or 14-EAM were retrospectively enrolled. The eradication rates were identified using per-protocol (PP) analysis. H. pylori eradication was confirmed by a 13C-urea breath test (UBiT-IR300®; Otsuka Electronics, Co., Ltd., Osaka, Japan) or a rapid urease test (CLOtest®; Delta West, Bentley, Australia) at least 4 weeks after completion of eradication therapy.
RESULTS
A total of 487 and 82 patients received 7-RBMT and 14-EAM, respectively. PP eradication rates were 93.6% (366/391; 95% CI, 91.0-95.9%) with 7-RBMT and 73.8% (48/65; 95% CI, 63.1-84.6%) with14-EAM (p < 0.001). Therefore, the eradication rates with 7-RBMT were significantly higher than with 14-EAM according to the PP analysis. The adverse event rate was 17.1% (67/391) with 7-RBMT and 7.7% (5/65) with 14-EAM (p=0.065). In terms of risk factors, multivariate analysis revealed that 14-EAM (OR, 5.47; 95% CI, 2.74-10.93) was related to H. pylori eradication failure.
CONCLUSIONS
7-RBMT may be an effective second-line therapy in patients who failed to respond to first-line triple therapy in Korea, where there is a high prevalence of H. pylori infection.

Keyword

Helicobacter pylori; Disease eradication; Bismuth tripotassium dicitrate; Moxifloxacin

MeSH Terms

Bismuth*
Breath Tests
Disease Eradication
Helicobacter pylori*
Helicobacter*
Humans
Korea
Multivariate Analysis
Prevalence
Retrospective Studies
Risk Factors
Urease
Bismuth
Urease

Figure

  • Fig. 1 Flowchart of study participants. PPI, proton pump inhibitor; PP, per-protocol.

  • Fig. 2 Helicobacter pylori eradication rates of second line 7-day bismuth-containing quadruple therapy (, p=0.579) and 14-day moxifloxacin-containing triple therapy (, p=0.932) according to year. PP, per-protocol.


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