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Canadian Journal of Gastroenterology
Volume 15, Issue 9, Pages 581-585
Original Article

Bismuth-Based Quadruple Therapy with Bismuth Subcitrate, Metronidazole, Tetracycline and Omeprazole in the Eradication of Helicobacter pylori

Raymond Lahaie,1 Alain Farley,2 Chrystian Dallaire,3 André Archambault,4 Carlo A Fallone,5 Terry Ponich,6 Richard Hunt,7 Michael Oravec,8 Paul Whitsitt,8 Sander Veldhuyzen Van Zanten,9 Norman Marcon,10 Robert Bailey,11 André Dumont,1 Bich Nguyen,1 Sylvain Desrochers,12 and Jean Spénard13,14

1Centre Hospitalier de l’Université de Montréal, Hôpital St-Luc, Montréal, Canada
2Centre de Gastro-Entérologie et d’Endoscopie de Montréal, Montréal, Canada
3Centre Hospitalier St François d’Assisse, Québec, Canada
4Hôpital Maisonneuve-Rosemont, Montréal, Canada
5McGill University Health Center, Montreal, Quebec, Canada
6London Health Science Centre, Victoria Campus, London, Canada
7McMaster University, Hamilton, Canada
8Oshawa Clinic, Oshawa, Ontario, Canada
9Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
10Wellesley Hospital, Toronto, Ontario, Canada
11Hys Center, Edmonton, Alberta, Canada
12Cirion Biopharma Research Inc, Laval, Canada
13Axcan Pharma Inc, Mont-Saint-Hilaire, Canada
14Faculé de Médicine, Department de Pharmacologie, Université de Montréal, Montréal, Québec, Canada

Received 6 February 2001; Accepted 17 July 2001

Copyright © 2001 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: A previous study showed that 14 days of qid bismuth-based triple therapy with tetracycline 500 mg, metronidazole 250 mg and colloidal bismuth subcitrate 120 mg resulted in excellent Helicobacter pylori eradication rates (89.5%). The present study looked at a shorter treatment period by adding omeprazole and by reducing the dose of tetracycline.

METHODS: One hundred sixty-one patients with H pylori confirmed by histology and 13carbon urea breath test were included in the study. They were treated for seven days with bismuth subcitrate 120 mg plus metronidazole 250 mg plus tetracycline 250 mg qid plus omeprazole 20 mg bid (OBMT). Patients were 18 to 75 years of age and had dyspepsia with or without a history of peptic ulcer. Patients with irritable bowel syndrome, active ulcer or previous attempt at eradication, or those who had used antibiotics or antiulcer drugs in the previous 30 days were excluded. Eradication was determined by two 13carbon urea breath tests done one and three months, respectively, after treatment. Strains with minimal inhibitory concentrations of 8 µg/mL or higher were considered to be resistant to metronidazole.

RESULTS: The overall per protocol eradication rate was 84% - 89.5% in metronidazole-sensitive and 70.8% in metronidazole-resistant strains. Modified intent-to-treat analysis resulted in a 80% eradication rate - 82.5% in metronidazole-sensitive and 66.7% in metronidazole-resistant strains. Only one patient discontinued treatment because of adverse events.

CONCLUSIONS: The OBMT regimen used in this study is safe and effective against metronidazole-sensitive H pylori strains.