Frontiers in Anti-Infective Drug Discovery

Volume: 8

Eradication of Helicobacter pylori Infection with Non-Bismuth Quadruple Concomitant Therapy

Author(s): Javier P. Gisbert and Adrian G. McNicholl

Pp: 1-34 (34)

DOI: 10.2174/9789811412387119080001

* (Excluding Mailing and Handling)

Abstract

Background: The main recommended regimens to eradicate Helicobacter pylori infection fail in ≥20% of the cases. Several substitutes for triple therapies have been proposed, and non-bismuth quadruple therapy is one of the most widely used.

Aim: To systematically review the efficacy of non-bismuth quadruple regimen (proton pump inhibitor, clarithromycin, amoxicillin and a nitroimidazole) in the eradication of H. pylori infection.

Methods: Bibliographical searches were performed in MEDLINE/EMBASE and relevant congresses. We pooled studies evaluating the concomitant regimen, and of the randomized controlled trials comparing concomitant vs. standard triple therapy, and concomitant vs. sequential therapy.

Results: Fifty-five studies were included (6,906 patients). The meta-analysis showed that concomitant regimen offers an overall eradication rate of 87%. A sub-analysis of studies comparing one-to-one concomitant and triple therapies showed an odds ratio of 2.14 (95% CI=1.51-3.04) towards higher efficacy with concomitant regimen. This figure increased up to 2.41 (95% CI=1.80-3.24; 85% vs. 72%) when comparing arms lasting the same number of days. We also sub-analyzed the comparative efficacy between non-bismuth quadruple concomitant and sequential treatments, and concomitant achieved an odds ratio of 1.49 (95% CI=1.21-1.85) towards higher eradication results than sequential regimen.

Conclusions: Non-bismuth quadruple (concomitant) therapy achieves high efficacy in H. pylori eradication, superior to standard triple and sequential therapy. Concomitant may be more appropriate than sequential therapy for patients with clarithromycin and/or metronidazole resistance. Higher acid suppression and/or longer duration are optimizations that can increase even more its efficacy.


Keywords: Amoxicillin, Clarithromycin, Concomitant therapy, Helicobacter pylori, Metronidazole, Non-bismuth quadruple, Proton pump inhibitor, Resistance, Sequential therapy, Treatment.

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      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 314383442 and j.to_ip >=314383442 )) and ((j.from_date <= 1740344793 and j.to_date >= 1740344793 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 13104) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 314383442 and j.to_ip >=314383442 )) and ((j.from_date <= 1740344793 and j.to_date >= 1740344793 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 13104) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 314383442 and j.to_ip >=314383442 )) and ((j.from_date <= 1740344793 and j.to_date >= 1740344793 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 13104)
      600μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 2661 and `b`.`banner_from_date` <= 1740344793 and `b`.`banner_to_date` >= 1740344793 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.12msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 2661
      • 3: 1740344793
      • 4: 1740344793
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='4265664c0a58dfa3a493bffbc2b10176'
      240μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    10Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        8gXEL67eKHNOCC6y1KmFY0d6hAqvNguH1JPadwHC
        uc_cart_id
        4265664c0a58dfa3a493bffbc2b10176
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/13104" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/13104
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:17 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "cookie" => array:1 [ 0 => "wayfindertarget=eyJpdiI6Ilc1cDhrSkNMQlEydG5WWnZiNFM1OFE9PSIsInZhbHVlIjoiVENaMnVZS3U3L2R4WWs1Zm5IWlNyc29YV2VZMFN1TEN4N2FIRndQcmR1az0iLCJtYWMiOiJjOGJlYzA3MzllNDhlNjFiMWNhNzI2ODAzNmUxNWZjYjkyYTc4OGE1MWQ2ZmZiMTkzY2Y2YWMzZTFiYjI0NWVjIiwidGFnIjoiIn0%3Dwayfindertarget=eyJpdiI6Ilc1cDhrSkNMQlEydG5WWnZiNFM1OFE9PSIsInZhbHVlIjoiVENaMnVZS3U3L2R4WWs1Zm5IWlNyc29YV2VZMFN1TEN4N2FIRndQcmR1az0iLCJtYWMiOiJjOGJlYzA3MzllNDhl" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        0 of 0
        array:1 [ "wayfindertarget" => null ]
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Sun, 23 Feb 2025 21:06:33 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6ImtJbnhUTWVXWWUvSHZsSnhsaWpyZXc9PSIsInZhbHVlIjoiaEJLbXBhTm1ZNXVVZ0R1RjBCZ3RtaGM1T3R2V2VTUEJiU09RR0JUZ0FhNkFTZHVyemF1cktWUlRPVHhvWHFrSkQ0UWFCd24rSGQ1alhreVJQV2gwUlRHd1Z5bHRHa096QWs2MEFLUGk0ZWhhVHY3S1hKWXJ5SkpSa3ZCM3VyeTciLCJtYWMiOiIyMjBkMDkyOTdkMTNhYWI3ODc3NTkzNWQ0ZmQ0MjQyZTUyYjRkYmQyYTJkZGViMGZiOTJmNjRiODkyYzFiMmI2IiwidGFnIjoiIn0%3D; expires=Wed, 26 Feb 2025 09:06:33 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6ImtJbnhUTWVXWWUvSHZsSnhsaWpyZXc9PSIsInZhbHVlIjoiaEJLbXBhTm1ZNXVVZ0R1RjBCZ3RtaGM1T3R2V2VTUEJiU09RR0JUZ0FhNkFTZHVyemF1cktWUlRPVHhvWHFrSkQ0UWFCd" 1 => "alphaeurekaselectnet_session=eyJpdiI6IkY5RjlLOXNzRk55K1lUVUprSmVZUEE9PSIsInZhbHVlIjoicHR6VDBSamJwK3BCTVoralE5QzdISjJRRmowbjVhOG02WnBJRFVONFA3aFVrMmVpelIxOWdrbzVsT3NIZUtyOUVhWnBGR0F3TUlTcXd6STBMTjRxZGoreGhlUFFGU3NHTjJ1c0NiR29yUnltcUNUSVQ1TWp1RXVPY1lxMUVMS08iLCJtYWMiOiI5ZDdiYTEwZWFmODJlNzA1MmUxZDcwYTc1Yjk3MzhkZjA0ZjNjYzczYjk4MzYzMjE2NDE4YTYyOGE1OWQzM2RhIiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6IkY5RjlLOXNzRk55K1lUVUprSmVZUEE9PSIsInZhbHVlIjoicHR6VDBSamJwK3BCTVoralE5QzdISjJRRmowbjVhOG02WnBJRFVONFA3aFVrMmVpelIxOWdrbzV" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6ImtJbnhUTWVXWWUvSHZsSnhsaWpyZXc9PSIsInZhbHVlIjoiaEJLbXBhTm1ZNXVVZ0R1RjBCZ3RtaGM1T3R2V2VTUEJiU09RR0JUZ0FhNkFTZHVyemF1cktWUlRPVHhvWHFrSkQ0UWFCd24rSGQ1alhreVJQV2gwUlRHd1Z5bHRHa096QWs2MEFLUGk0ZWhhVHY3S1hKWXJ5SkpSa3ZCM3VyeTciLCJtYWMiOiIyMjBkMDkyOTdkMTNhYWI3ODc3NTkzNWQ0ZmQ0MjQyZTUyYjRkYmQyYTJkZGViMGZiOTJmNjRiODkyYzFiMmI2IiwidGFnIjoiIn0%3D; expires=Wed, 26-Feb-2025 09:06:33 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6ImtJbnhUTWVXWWUvSHZsSnhsaWpyZXc9PSIsInZhbHVlIjoiaEJLbXBhTm1ZNXVVZ0R1RjBCZ3RtaGM1T3R2V2VTUEJiU09RR0JUZ0FhNkFTZHVyemF1cktWUlRPVHhvWHFrSkQ0UWFCd" 1 => "alphaeurekaselectnet_session=eyJpdiI6IkY5RjlLOXNzRk55K1lUVUprSmVZUEE9PSIsInZhbHVlIjoicHR6VDBSamJwK3BCTVoralE5QzdISjJRRmowbjVhOG02WnBJRFVONFA3aFVrMmVpelIxOWdrbzVsT3NIZUtyOUVhWnBGR0F3TUlTcXd6STBMTjRxZGoreGhlUFFGU3NHTjJ1c0NiR29yUnltcUNUSVQ1TWp1RXVPY1lxMUVMS08iLCJtYWMiOiI5ZDdiYTEwZWFmODJlNzA1MmUxZDcwYTc1Yjk3MzhkZjA0ZjNjYzczYjk4MzYzMjE2NDE4YTYyOGE1OWQzM2RhIiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6IkY5RjlLOXNzRk55K1lUVUprSmVZUEE9PSIsInZhbHVlIjoicHR6VDBSamJwK3BCTVoralE5QzdISjJRRmowbjVhOG02WnBJRFVONFA3aFVrMmVpelIxOWdrbzV" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "8gXEL67eKHNOCC6y1KmFY0d6hAqvNguH1JPadwHC" "uc_cart_id" => "4265664c0a58dfa3a493bffbc2b10176" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/13104" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-23 21:06:33GET/chapter/131041121912