Bismuth-based quadruple therapy for Helicobacter pylori - a single triple capsule plus lansoprazole

Background: Recently a new 'all in one' single capsule with the three compo nents of bismuth-based triple therapy became available in trials for treati ng Helicobacter pylori. Aim: To investigate the efficacy and tolerability of this new capsule when combined with lansoprazole. Methods: A total of 66 consecutive infected patients from a single centre r eceived two single triple capsules four times daily and lansoprazole 30 mg b.d. for 7 days. Each capsule contained 60 mg of bismuth subcitrate, 125 mg of tetracycline and 125 mg of metronidazole. Endoscopy with biopsies for C LO-test, histology and culture from antrum and corpus was performed before and at least 5 weeks after treatment. Results: The per protocol cure rate was 56/64 (88%, 95% CI: 79-95%); by int ention-to-treat 56/65 (86%, 95% CI: 78-95%). The per protocol cure rate in metronidazole sensitive strains was 40/43 (93%, 95% CI: 85-100%); in resist ant strains 5/9 (56%, 95% CI: 23-88%). There was one drop-out due to advers e events. Conclusions: It is possible to combine the components of bismuth-based trip le therapy into a single capsule. Based on the results it can be assumed th at the capsule releases its content in the stomach. When combined with lans oprazole it reaches high cure rates, especially in metronidazole sensitive strains. This new approach simplifies bismuth-based anti-Helicobacter thera py.