First-Line Bismuth, Concomitant, or Triple Therapy for Helicobacter pylori Infection?

Increasing antibiotic resistance has made the optimal first-line therapy for Helicobacter pylori infection unclear. To compare H. pylori eradication rates among three first-line regimens, investigators in Taiwan conducted a multicenter, randomized, open-label trial in which 1620 patients with H. pylori infection received 10-day bismuth quadruple therapy (bismuth, lansoprazole, tetracycline, and metronidazole), 10-day concomitant therapy (lansoprazole, amoxicillin, clarithromycin, and metronidazole), or 14-day triple therapy (lansoprazole, amoxicillin, and clarithromycin). Eradication was determined by urea breath testing ≥6 weeks after completion of therapy. Data on antibiotic resistance were available for 999 patients.

Intention-to-treat er…