What are the components of Helicobacter pylori (H. pylori) quadruple therapy with bismuth?

From the Guidelines

Bismuth-containing quadruple therapy for H. pylori infection consists of a proton pump inhibitor (PPI), bismuth subsalicylate or bismuth subcitrate, tetracycline, and metronidazole, with a typical regimen including a PPI twice daily, bismuth subsalicylate 525mg four times daily, tetracycline 500mg four times daily, and metronidazole 500mg three to four times daily for 14 days, as recommended by the most recent guidelines 1. The components of this therapy work together to effectively eradicate H. pylori infection, with the bismuth component providing direct antimicrobial activity and helping to prevent antibiotic resistance, while the tetracycline and metronidazole work synergistically to eliminate the bacteria, and the PPI reduces stomach acid production, creating a more favorable environment for the antibiotics to work and helping to heal any existing ulcers. Key points to consider when prescribing bismuth quadruple therapy include:

• The dose and frequency of each medication, with the PPI typically given twice daily, and the bismuth, tetracycline, and metronidazole given three to four times daily 1
• The importance of completing the full course of treatment, even if symptoms improve before completion, to ensure effective eradication of the infection
• Potential side effects, including darkening of the stool from bismuth, metallic taste, nausea, and gastrointestinal discomfort, which should be monitored and managed as needed
• The effectiveness of this therapy in patients who have failed initial treatment or have antibiotic resistance concerns, making it a valuable option for refractory H. pylori infection 1.

From the Research

H. Pylori Quadruple Therapy with Bismuth

The composition of H. Pylori quadruple therapy with bismuth can vary, but some common combinations include:

• Rabeprazole + Bismuth + Furazolidone + Tetracycline 2
• Lansoprazole + Bismuth + Amoxycillin + Clarithromycin 2
• Omeprazole + Amoxicillin + Clarithromycin + Bismuth Potassium Citrate 3
• Lansoprazole + Tetracycline + Metronidazole + Bismuth subsalicylate 4 Some key points to consider:
• The efficacy and safety of these regimens can vary depending on the specific combination of drugs and the population being treated 2, 3, 4
• The presence of antibiotic resistance can affect the efficacy of these regimens, and the use of bismuth may help to overcome resistance to certain antibiotics 3, 4
• The duration of treatment can also impact the efficacy of these regimens, with longer treatment durations (e.g. 14 days) potentially leading to higher eradication rates 3

Common Components of H. Pylori Quadruple Therapy with Bismuth

Some common components of H. Pylori quadruple therapy with bismuth include:

• A proton pump inhibitor (PPI) such as lansoprazole, omeprazole, or rabeprazole
• An antibiotic such as amoxicillin, clarithromycin, or metronidazole
• Bismuth, which can be in the form of bismuth subsalicylate or bismuth potassium citrate
• A second antibiotic such as tetracycline or furazolidone

Efficacy and Safety of H. Pylori Quadruple Therapy with Bismuth

The efficacy and safety of H. Pylori quadruple therapy with bismuth can vary depending on the specific combination of drugs and the population being treated. Some studies have reported high eradication rates with these regimens, while others have reported lower efficacy and higher rates of adverse events 2, 3, 4, 5.