Quadruple concomitant non-bismuth therapy vs. classical triple therapy as first line therapy for Helicobacter pylori infection ☆ ☆☆

Abstract Background and objective In a previous study we found that the classical triple therapy for Helicobacter pylori (H. pylori) had low efficacy (under 70%) in our area. After this finding, in mid 2012 quadruple concomitant therapy started to be prescribed in our hospital. The aim of the present study is to compare the efficacy of classical triple therapy and quadruple concomitant therapy without bismuth. Materials and methods Observational retrospective study of prescribed treatments between 1st January 2012 and 5th May 2014 and their efficacy. Results During the study period 510 patients were prescribed a first line therapy; in 179 cases (35.1%) the combination amoxiciline + clarithromicine + PPI was prescribed during 7–14 days, and 298 patients (58.4%) were treated with amoxicillin + clarithromycin + metronidazole + PPI for 10 days. The quadruple concomitant therapy had a higher efficacy than the classical triple therapy, both in an “intention to treat” (84.8% vs. 65.7%, P  = .001) and “per protocol” (86.9% vs. 67.2%, P  = .001) analysis. Triple therapy had a higher efficacy when it was prescribed for 10 days compared to 7 days (77.9% vs. 56.5%, P  = .005 per “intention to treat” and 77.9% vs. 58.5%, P  = .011 “per protocol”). When quadruple concomitant therapy was compared with classical triple therapy prescribed over 10 days no significant differences were found. Conclusions In our setting, quadruple concomitant therapy without bismuth has a high efficacy as first line therapy for H. pylori eradication, with much better results than classical triple therapy in the way that it is most widely prescribed (short courses of 7-day with a single dose of omeprazole).