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Background/Aims: Bismuth-based quadruple therapy (BQT) is a treatment option for clarithromycin-resistant Helicobacter pylori (HP) infection.The aim of this study was to compare the efficacy of 7-day BQT with that of 14-day BQT as first-line treatment for clarithromycin-resistant HP infection.Methods: A total of 162 treatment-naïve patients with peptic ulcer disease and clarithromycinresistant HP infection confirmed by real-time polymerase chain reaction (RT-PCR) were enrolled.The enrolled patients were prospectively randomized to receive BQT for either 7 or 14 days of treatment.Eradication of HP infection was assessed using a 13 C-urea breath test.Eradication and adverse event rates of the two groups were assessed. Results:The overall eradication rates in the intention-to-treat (ITT) and per-protocol (PP) analyses were 83.0%(95% confidence interval CI, 77.2% to 88.9%; 132/159) and 89.8% (95% CI, 84.9% to 94.7%; 132/147), respectively.The eradication rates in the ITT analysis were 79.0% (64/81) in the 7-day group and 87.2% (68/78) in the 14-day group (p=0.170).The eradication rates in the PP analysis were 86.5% (64/74) in the 7-day group and 93.2% (68/73) in the 14-day group (p=0.182).Clinically significant adverse events occurred in 18.2% of patients.There was no statistically significant difference in the rates of individual or all adverse events between the two groups.Conclusions: Both 7-day and 14-day BQT were effective and safe as first-line therapy for HP infections identified as resistant to clarithromycin by RT-PCR.For clarithromycin-resistant HP infections, 7-day BQT may be sufficient as first-line therapy.(Gut Liver, Published online May 7,
Lim et al. (Tue,) studied this question.