Lancet 2016;388(10058):2355-65. OBJECTIVE: To evaluate the efficacy of 14-day ranitidine bismuth citrate (RBC) base quadruple therapy after H. pylori treatment failure in Thai patients. Abstract.
Often, people with the infection have to use triple antibiotic therapy or quadruple therapy, which involves antibiotics and medications to reduce stomach acid. Bismuth + proton pump inhibitor (PPI) + amoxicillin + levofloxacin is one of the bismuth quadruple therapy regimens widely used for the eradication of H. pylori infection. Thus, it has to be concluded that quadruple therapy should be considered as the first-line therapy in areas with a high prevalence of clarithromycin-resistant H. pylori strains.

H. Pylori is a difficult infection to treat with conventional antibiotics because of problems such as antibiotic resistance. Concomitant, bismuth quadruple, and 14-day triple therapy in the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. BACKGROUND: A quadruple therapy with a proton pump inhibitor, bismuth, metronidazole and tetracycline is recommended as a second line therapy after Helicobacter pylori treatment failure. Few patients with a history of peptic ulcer are treated by their GP for H. pylori infection, even though theoretical evidence supports such an approach.. Furthermore, probiotics show a positive impact on H. pylori therapy-related side effects.." (4) quadruple therapy for H. pylori.

Background. After completion of the trial, we again searched PubMed for articles published between Jan 1, 1990, and June 30, 2016. We searched specifically for randomised trials comparing the efficacy of two of bismuth quadruple therapy, concomitant therapy, or 14-day triple therapy in the first-line treatment of H pylori in adults. a meta-analysis revealed that quadruple therapy appeared to be more effective than triple therapies for eradicating single-drug resistant H. pylori infection (5) “In the face of rising prevalence of clarithromycin resistance, bismuth quadruple therapy should be considered as the first-line treatment of H. pylori infection in our daily practice,” said Dr. Jyh-Ming Liou from National Taiwan University Hospital, National Taiwan University College of Medicine, in Taipei. Objectives. We aimed to determine the validity of this recommendation and to test the feasibility of quadruple therapy …

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