Efficacy of bismuth‐based quadruple therapy for eradication of Helicobacter pylori infection based on previous antibiotic exposure: A large‐scale prospective, single‐center clinical trial in China

Abstract Objective This study aims to evaluate the efficacy and safety of three bismuth‐based quadruple regimens for eradication of Helicobacter pylori ( H pylori ) infection in a large number of H pylori ‐positive patients with or without previous eradication therapy. Methods Consecutive adult patients with H pylori infection, regardless of previous eradication therapy, were eligible for the present study. Three bismuth‐based quadruple regimens were selected according to the past history of antibiotics use: (A) esomeprazole, amoxicillin, clarithromycin, and colloidal bismuth tartrate; (B) esomeprazole, amoxicillin, furazolidone, and colloidal bismuth tartrate; and (C) esomeprazole, doxycycline, furazolidone, and colloidal bismuth tartrate. All patients received a 14‐day course of treatment, and 13 C/ 14 C urea breath test was utilized at four weeks after the completion of treatment to determine the H pylori eradication. Then, the eradication rates were calculated in terms of intention‐to‐treat (ITT) and per‐protocol (PP) analyses. Adverse events (AEs) were recorded during the treatment. Results Overall, 1,226 patients were recruited, and 331, 57, and 838 patients were allocated to receive regimens A, B, and C, respectively. The H pylori eradication rates were 84.0%, 82.5%, and 82.9% (ITT) and 94.6%, 92.2%, and 93.7% (PP), respectively, in regimens A, B, and C. However, there was no significant difference among these three regimens. The incidence of AEs was 4.6% for all patients during the study, that is, 3.3%, 10.5%, and 4.7% for regimens A, B, and C, respectively. All AEs were mild and recovered at the follow‐up visit. Conclusion All three bismuth‐based quadruple regimens based on the previous antibiotic use can achieve satisfactory eradication rates for H pylori infection and are safe.