A recent study demonstrated that in patients infected with H.pylori, a two-week mBCQT and concomitant therapy regimens have high H.pylori eradication rates. Most patients demonstrate good compliance. Compared to mBCQT, more concomitant therapy patients experience adverse events.

In a single tertiary medical center, a prospective, randomized, open-label controlled study was conducted to compare modified bismuth-containing quadruple therapy (mBCQT) and concomitant therapy as potential first-line treatments for H. pylori infection. Overall, 136 participants were randomly allocated to receive either mBCQT (n=68) or concomitant therapy (n=68) for two weeks.

A proton pump inhibitor (PPI), bismuth, metronidazole, and tetracycline, taken twice daily were included in the mBCQT. A PPI, clarithromycin, metronidazole, and amoxicillin, taken twice daily were included in the concomitant therapy. H.pylori eradication rates,  the associated adverse events, and compliance were evaluated.

To confirm eradication, the 13C-urea breath test was carried out no earlier than four weeks after the therapy concluded. H.pylori infection was diagnosed if either the histological or rapid urease test was positive.

The demographic characteristics of patients receiving mBCQT and concomitant therapy did not differ considerably. On intention-to-treat analysis and per-protocol analysis, the eradication rate was more in the mBCQT group compared to the concomitant therapy group, as shown in the following table: 

Compared to patients receiving mBCQT, adverse events were witnessed more in patients receiving concomitant therapy. All patients depicted good compliance, as depicted in the following table:

Thus, both mBCQT and concomitant therapy are valuable empirical first-line treatment options for H. pylori eradication. Considering both compliance and side effects, mBCQT is somewhat preferable. There is a requisition of a large-scale prospective study to authenticate the findings.