A seven-day concomitant treatment (non-bismuth concomitant quadruple therapy) with either esomeprazole or lansoprazole showed comparable rates of eradication in H.pylori infected patients. Also, the eradications were possibly affected by metronidazole-resistant strains.

This retrospective analysis compared the rates of eradication of non-bismuth concomitant quadruple therapy comprising of either esomeprazole and lansoprazole for first-line anti-H. pylori treatment.

In total, 206 H. pylori-infected patients were enrolled and assigned into two groups based on esomeprazole and lansoprazole based concomitant therapies as:

• EACM group: Esomeprazole 40 mg + Amoxicillin 1 g + Metronidazole 500 mg; and Clarithromycin 500 mg all taken twice daily for 7 days
• LACM group: Lansoprazole 30 mg + Amoxicillin 1 g + Metronidazole 500 mg; and Clarithromycin 500 mg  all taken twice daily

After 8 weeks, patients were asked to carry out urea breath tests.

Rates of eradication in the EACM group and LACM group in intention-to-treat (ITT) and the per-protocol (PP) analysis is depicted in the following table:

Patients in the LACM group displayed more diarrhea compared to the EACM group (7.1% vs. 1.0%), however, all were mild symptoms. Metronidazole resistance was the clinical feature influencing the eradications as per the univariate analysis. Furthermore, a trend was witnessed in dual metronidazole- and clarithromycin-resistant strains. 

Non-bismuth concomitant quadruple therapy with either esomeprazole or lansoprazole provided similar outcomes concerning eradication rates for first-line therapy for H. pylori. In the PP analysis, both groups could attain more than 90% elimination of H. pylori.