Efficacy Of Different Durations Of Bismuth-containin Quadruple Therapy In Patients With Helicobacter Pylori Infection

Objective:The study aimed to observe the efficacy of different durations (7days and14days) of bismuth, esomeprazole, levofloxacin and amoxicillin-containing quadruple therapy on the eradication of H. pylori.Method:This study included218H. pylori-infected cases, of which33patients failed the H. pylori eradication after at least one treatment(29cases failed once,4cases failed twice or more than twice). All the patients received levofloxacin200mg twice a day, esomeprazole20mg twice a day, amoxicillin1000mg twice a day, bismuth potassium citrate600mg (equivalent to220mg of bismuth) twice a day. In the beginning phrase of the study, patients mainly took these drugs for14days, while a part of them took7-day treatment. In the second period, the H. pylori-infected patients were randomly devided into two groups which received7-day or14-day drugs. At least4weeks after the end of therapy, patients conducted the urea breath test. According the intent-to-treat(ITT) analysis and per-protocol(PP) analysis, H. pylori eradication rate and95%confidence interval (95%CI) were calculated.Results:In the beginning phrase of the study, according to ITT analysis, EBAL7and EBAL14demonstrated the eradication rate of88.2%and92.5%(χ2=0.329, P=0.567); according to PP analysis, eradication rate of two groups were93.8%and95.4%(χ2=0.07, P=0.787). The differences showed no statistical significance. Randomized groups consisted of134cases. According to ITT analysis, the eradication rates in EBAL7and EBAL14were71.6%(95%CI=60.8%to82.4%) and95%(95%CI=74.7%to92.4%) respectively(χ2=2.794, P=0.097). According to PP analysis, eradication rates in the two groups were81.4%(95%CI=71.4%-91.3%) and96.6%(95%CI=91.7%-100%), and the difference showed statistical significance (x2 =6.838, P=0.009). Regardless of the duration of7-day or14-day, the eradication rate difference was no statistically significant between patients with peptic ulcer and with gastritis. When compared with7-day therapy,14-day therapy demostrated a higher eradication rate in those who received the therapy for the first time (PP analysis, χ2=4.709, P=0.030). The incidence of side effects was about6.0%in EBAL7, and9.0%in EBAL14(P <0.05).Conclusion:Forteen-day quadruple therapy containing bismuth, esomeprazole, levofloxacin and amoxicillin was an effective strategy for H. pylori eradication, which performed nice efficacy, good compliance and little side effects, especially in first-treated patients.