Addressing the rising antibiotic resistance, especially clarithromycin resistance which affects the Helicobacter pylori eradication therapy is quite challenging. In this study, the use of bismuth and triple therapy was found to be effective for this bacterial infection based on elevated eradication rates and high clarithromycin tolerance.

The main aim of the study was to investigate the effectiveness of bismuth combined with triple therapy as a first‐line treatment for Helicobacter pylori (H. pylori) infection. 

One hundred and seven patients infected with H. pylori on H. pylori eradication therapy (combination of bismuth and triple therapy) for 2 weeks were included. Dual‐priming oligonucleotide‐based multiplex PCR was used to assess the clarithromycin resistance rate.

One hundred and four patients completed this combination therapy. High bacterial eradication rate i.e. 87.9% and 90.4% was observed as per the intention-to-treat analysis and per protocol analysis. Occurrence of clarithromycin resistance was 33.6% (35 patients out of 104 patients), and eradication rate was 77.1% in resistant strains (27 patients out of 35 patients).

In patients with clarithromycin‐resistant strains, the combined use of Bismuth and triple therapy could serve as a suitable first‐line treatment routine for H. pylori eradication. Especially, in patients with high clarithromycin tolerance, bismuth when used as an add‐on therapy can be regarded as a first‐line treatment routine.