Esomeprazole, minocycline, metronidazole and bismuth as first-line and second-line regimens for Helicobacter pylori eradication

ABSTRACT

OBJECTIVE

Because of general unavailability of tetracycline, relatively high adverse effect risk and complicated administration, the clinical application of bismuth quadruple therapy often faces great difficulty. Whether minocycline can replace tetracycline for Helicobacter pylori eradication remains unclear. The aim of this study was to determine the efficacy, safety, compliance and risk factors of esomeprazole, minocycline, metronidazole and bismuth (EMMB) regimen for Helicobacter pylori eradication.

METHODS

In this prospective single-center study, 152 patients in first-line therapy group and 64 patients in second-line therapy group were enrolled and received EMMB therapy (esomeprazole 20 mg twice/day, minocycline 100 mg twice/day, metronidazole 400 mg four times/day and bismuth potassium citrate 110 mg four times/day) for 14 days. Eradication outcome was assessed by urea breath test 6-12 weeks after treatment.

RESULTS

EMMB therapy achieved the eradication rates of 85.5% (95% confidence interval 79.6%-91.4%; intention-to-treat analysis), 90.3% (84.7%-95.1%; modified intention-to-treat analysis) and 92.6% (88.1%-96.3%; per-protocol analysis) in first-line therapy group; while 82.8% (71.9%-90.6%), 86.9% (77.1%-95.1%) and 89.5% (80.7%-96.5%) in second-line therapy group, respectively. In first-line therapy group, 35.6% patients had adverse effects, 4.7% discontinued medications because of adverse effects and good compliance was achieved in 91.3% patients, while 36.5%, 3.2% and 90.5% in second-line therapy group, respectively. Factor analysis identified poor compliance as an independent predictor of treatment failure.

CONCLUSIONS

The eradication efficacies of EMMB therapy as first-line and second-line regimens in the region with high rates of antibiotic resistance were satisfactory with relatively good compliance and safety. This article is protected by copyright. All rights reserved.

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