Background/aims: Point mutations in the 23S ribosomal RNA gene have been associated with Helicobacter pylori (H. pylori) clarithromycin resistance and bismuth-based quadruple therapy (BQT) is one of the options for the treatment of clarithromycin-resistant H. pylori. Current H. pylori treatment guidelines recommend BQT for 10-14 days. This study aims to compare the eradication extents according to 7-day and 14-day BQT treatment for treatment-naïve clarithromycin-resistant confirmed H. pylori infection.
Methods: We retrospectively investigated treatment-naïve H. pylori infection cases from March 2019 to December 2020, where patients were treated with BQT. Clarithromycin resistance was identified with a dual-priming oligonucleotide-based multiplex polymerase chain reaction method. We reviewed a total of 126 cases. Fifty-three subjects were treated with a 7-day BQT regimen (7-day group), and 73 subjects were treated with a 14-day BQT regimen (14-day group). We evaluated the total eradication extent of the BQT and compared the eradication extents of the two study groups.
Results: Total eradication extent of H. pylori was 83.3% (105/126). The eradication extents of the two groups were as follows: 7-day group (81.1% (43/53)), 14-day group (84.9% (62/73), p = 0.572) by intention-to-treat analysis; 7-day group (95.6% (43/45)), 14-day group (92.5% (62/67), p = 0.518) by per-protocol analysis. The moderate or severe adverse event extents during the eradication were 30.2% (16/53) in the 7-day group and 19.2% (14/73) in the 14-day group (p = 0.152).
Conclusions: The 7-day BQT regimen was as effective as the 14-day BQT regimen in the eradication of treatment-naïve clarithromycin-resistant H. pylori infection.
Keywords: Helicobacter pylori; bismuth; clarithromycin; duration of therapy; point mutation.