A Randomized, Prospective and Crossover Study, Comparing the Eradication Rate After 10 Days of Concomitant Therapy to Bismuth Quadruple Therapy Among a Sample of the Lebanese Population.

BACKGROUND

Concomitant therapy and bismuth quadruple therapy are both recommended as first-line treatment regimens for the empiric treatment of infection, especially after the increased resistance to clarithromycin.

OBJECTIVE

Our goal was to compare both treatment regimens among a sample of the Lebanese population to eventually conclude whether one of these therapies has a higher efficacy than the other one as a first- and second-line treatment regimens.

METHODS

It is a randomized, prospective, and crossover study, started from March 2016 to December 2018. Participants were randomly chosen patients diagnosed with active through histology. Two groups were then formed randomly and equally: patients in the first group received 10 days of concomitant therapy, whereas patients in the second group received 10 days of bismuth quadruple therapy. Eradication was evaluated by the C urea breath test done 6 weeks after the end of antibiotic use. A negative breath test indicated a successful eradication. All patients with a positive breath test were then given the other treatment regimen for another 10 days and then re-evaluated for eradication in the same manner.

RESULTS

Both regimens demonstrated similar efficacy as first-line therapies for eradication. Among 175 patients receiving concomitant therapy, 160 (91.4%) achieved eradication, whereas in the 174 patients treated with bismuth quadruple therapy, 164 (94.2%) were successfully eradicated ( = 0.306). Among patients requiring second-line treatment, 14 of 15 (93.3%) who failed concomitant therapy were successfully treated with bismuth quadruple therapy, whereas all 10 patients (100%) who failed bismuth therapy achieved eradication with concomitant therapy ( < 0.001).

CONCLUSIONS

Bismuth quadruple therapy and concomitant therapy are both equally effective first-line treatment regimens for the eradication of . They are also effective if used as second-line treatment regimens for this purpose. Lebanese Clinical Trials Registry identifier: LBCTR2024095653.