Abstract

Clarithromycin-containing bismuth quadruple therapy has been recommended as the first-line therapy for Hpylori infection in China. However, its expensive cost and high antibiotic-related adverse reactions are always haunting us. To find a safer, more cost-effective, and high eradicative strategy for Helicobacter treatment, we investigated the efficacy of 14-day bismuth quadruple therapy and different doses of clarithromycin in the first-line treatment. A total of 210 patients with Hpylori infection were recruited and randomly assigned to half-dose clarithromycin group (esomeprazole 20mg bid, amoxicillin 1g bid, clarithromycin 250mg bid, and bismuth potassium citrate 0.6g bid) for 14days or standard-dose clarithromycin group (esomeprazole 20mg bid, amoxicillin 1g bid, clarithromycin 500mg bid, and bismuth potassium citrate 0.6g bid) for 14days. A 13 C-urea breath test (13 C-UBT) was performed at least 4weeks after treatment. The eradication rate of Hpylori, the incidence of side effects, and the cost-effectiveness of regimens were evaluated in this study. The eradication frequencies were 86.67% for both groups in the intention-to-treat analysis, while the per-protocol eradication rates were 91% vs. 91.92% (p=0.817). The incidence of adverse events was higher in standard dose group (54.21% vs. 34.29%; p=0.004), especially bitter taste symptom. There was a higher level of costs per person associated with the standard-dose group as compared with half-dose group (¥804.3 vs ¥654.36). The cost-effectiveness ratio of the half dose was less than that of the standard dose (7.55 vs 9.16 CNY per percent). A 14-day half-dose clarithromycin-containing bismuth quadruple regimen is as effective as the standard bismuth quadruple therapy at eradicating Hpylori, which is better tolerated and more economical. (ChiCTR-ROC-15007406).

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