For first-line H. pylori eradication, 14-day Rabeprazole-containing hybrid therapy exhibited a higher eradication rate (94.2%) compared to high-dose dual therapy (77.0%).

To compare the safety and efficacy of 14-day high-dose dual therapy (HDDT) with hybrid therapy (HT) comprising of Rabeprazole in people with Helicobacter pylori (H. pylori) infection. Additionally, the study aimed to explore factors, both host and bacterial, that could predict therapy outcomes.

A total of 243 treatment-naïve patients with H. pylori infection were enrolled in this randomized controlled open-label study, conducted from September 1, 2018, to November 30, 2021. Volunteers were randomly allocated in a 1:1 ratio into two groups:

• HDDT group (n = 122): Received Rabeprazole 20 mg + Amoxicillin 750 mg four times every day for fourteen days
• HT group (n = 121): Received Rabeprazole 20 mg + Amoxicillin 1 g twice daily for 1 week, followed by Rabeprazole 20 mg + Amoxicillin 1 g + Clarithromycin 500 mg + Metronidazole 500 mg twice daily for another 1 week

In the per-protocol analysis, 12 patients in the HDDT group and 4 in the HT group were lost to follow-up, resulting in 110 patients in the HDDT group and 117 in the HT group. The eradication outcome was determined using urea breath tests after 8 weeks.

The elimination rates for H. pylori are summarized in Table 1.

Adverse effects were reported by more patients in the HT group (14.5%) compared to the HDDT group (7.3%). In the HDDT group, the regular consumption of coffee was found to be a predictive factor for eradication failure (88.2% versus 68.8%), while in the HT group, coffee consumption had no impact on eradication rates (97.9% versus 95.0%), according to univariate analysis.

Compared to 14-day HT with Rabeprazole, the use of 14-day HDDT with Rabeprazole did not achieve eradication rates >90% for first-line H. pylori treatment.