Bismuth containing quadruple therapy versus tailored therapy as first-line treatments for infection in a high clarithromycin resistance area.

Background: Increasing clarithromycin resistance has led to the need for an alternative first-line therapy for the eradication of () in Korea, and bismuth containing quadruple therapy (BQT) and tailored therapy (TT) have been proposed as alternative regimens. The aim of this study was to compare the eradication rates of BQT and TT as first-line eradication therapies.

Methods: infection was diagnosed using the rapid urease test or dual-priming oligonucleotide-based multiplex polymerase chain reaction (DPO-PCR) during endoscopy. Patients positive for were divided into two groups; those tested using the rapid urease test received empirical BQT (the BQT group) whereas those tested by DPO-PCR received TT (the TT group). Eradication rates, adverse events, and overall medical costs, which included diagnostic test and eradication regimen costs, were compared.

Results: Three hundred and sixty patients were included in the study (TT group 178, BQT group 182). The modified intention-to-treat eradication rates of BQT and TT were 88.2% (142/161) and 80.3% (118/147), respectively ( = .055), and corresponding eradication rates in the per-protocol population were 88.8% (142/160) and 81.4% (118/145) ( = .07). Compliance and adverse event rates were similar in the two groups. Average medical costs were $90.3 per patient in the TT group and $75.5 in the BQT group ( = .000).

Conclusions: Empirical BQT and tailored therapy were similar in terms of eradication rate, safety, and tolerability, but BQT was more cost-effective.