| Title: |
Bismuth Quadruple Therapy with Doxycycline Is an Effective First-Line Therapy for Helicobacter pylori in an Irish Cohort |
| Authors: |
Conor Costigan; Mark Comerford; Ronan Whitmarsh; Kevin Van Der Merwe; Gillian Madders; Jim O’Connell; Thomas Butler; Stephen Molloy; Fintan O’Hara; Barbara Ryan; Niall Breslin; Sarah O’Donnell; Anthony O’Connor; Sinead Smith; Syafiq Ismail; Vikrant Parihar; Deirdre McNamara |
| Source: |
Antibiotics, Vol 14, Iss 8, p 757 (2025) |
| Publisher Information: |
MDPI AG, 2025. |
| Publication Year: |
2025 |
| Collection: |
LCC:Therapeutics. Pharmacology |
| Subject Terms: |
Helicobacter pylori; H. pylori; H. pylori eradication; bismuth quadruple therapy; Therapeutics. Pharmacology; RM1-950 |
| Description: |
Background: There has been a reduction in successful H. pylori eradication rates recently, which is largely attributed to increasing antibiotic resistance. In areas of high dual clarithromycin and metronidazole resistance such as ours, Maastricht VI/Florence guidelines recommend bismuth quadruple therapy (BQT) as first line of therapy; however, the availability of bismuth was poor in Ireland until recently. Similarly, tetracycline, a component of BQT, is restricted locally, with doxycycline (D) being approved and reimbursed for most indications. Aims: To assess the efficacy of BQT-D therapy for H. pylori eradication in an Irish cohort. Methods: All patients testing positive for H. pylori in three Irish referral centres by urea breath test, stool antigen, or histology were treated prospectively with BQT-D (bismuth subcitrate 120 mg QDS, metronidazole 400 mg TDS, doxycycline 100 mg BD and esomeprazole 40 mg BD) for 14 days. Eradication was evaluated with a urea breath test (UBT) >4 weeks after therapy cessation or by stool antigen testing, as available. Outcomes were recorded and analysed according to demographics and H. pylori treatment history of the patients. Results: 217 patients completed post-eradication testing. Of which, 124 (57%) were female, with a mean age 52 years. 180 patients (83%) were treatment-naïve. A total of 165/180 (92%) of the treatment-naïve patients had successful eradication. There was no association between eradication and gender or age in this cohort (p = 0.3091, p = 0.962 respectively). A total of 29 patients received this therapy as second-line therapy, of which 22 (76%) had successful eradication. Eight patients received the regimen as rescue therapy, with seven (88%) having successful eradication. No serious adverse events were reported. Eleven individuals (6.5%) commented on the complicated nature of the regimen, with 11 tablets being taken at five intervals daily. Conclusions: BQT-D as first-line therapy for H. pylori infection is highly effective in a high dual-resistance population, achieving >90% eradication. BQT-D as a second-line treatment performed less well. Our data support BQT-D as a first-line treatment. |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
2079-6382 |
| Relation: |
https://www.mdpi.com/2079-6382/14/8/757; https://doaj.org/toc/2079-6382 |
| DOI: |
10.3390/antibiotics14080757 |
| Access URL: |
https://doaj.org/article/48dfd0ef0e3d4b63b1cb77909aa66403 |
| Accession Number: |
edsdoj.48dfd0ef0e3d4b63b1cb77909aa66403 |
| Database: |
Directory of Open Access Journals |