For first-line H. pylori management, tailored triple plus bismuth therapy on the basis of prior antibiotic use can yield greater elimination rates than empiric triple plus bismuth therapy.

A randomized trial was conducted to examine if tailored triple plus bismuth therapy (TBT) can attain greater elimination rates than empiric TBTs based on past antibiotic history.

Overall, 800 subjects who had never received therapy were divided into 4 arms at random receiving Clarithromycin-, Levofloxacin- or Metronidazole-containing empiric TBT and tailored TBT (Levofloxacin and Clarithromycin selected on the basis of prior Quinolones and Macrolides history). Analysis of correlations between prior drug use and elimination or resistance rates was done.

In intention-to-treat (89.5%, 80.8%, 81.5%, 81.5%) and per-protocol (95.1%, 86.7%, 86.5%, 87.8%) assessment, the elimination rates of tailored TBT were considerably greater when compared to Clarithromycin-, Levofloxacin-, and Metronidazole-containing empiric TBT.

Subjects who had previously taken Macrolides, Quinolones, or Nitroimidazoles had substantially greater rates of resistance to the corresponding Clarithromycin, Levofloxacin, or Metronidazole than subjects without past medication history, and the elimination rates of corresponding Levofloxacin- or Clarithromycin-containing empiric TBT was substantially lower.

Tailored TBT can yield greater H. pylori elimination rates than empiric TBT based on prior antibiotic use.