Comparative Effectiveness of H Pylori Treatments
A retrospective cohort study to evaluate the real-world effectiveness of empiric Helicobacter pylori (H. pylori) treatment found that two 14-day regimens achieved the highest eradication rates.
The investigators compared eradication rates among 26,669 individuals receiving initial therapy and 5389 who underwent salvage treatment within Kaiser Permanente Northern California— a large, community-based, and ethnically diverse U.S. population—over a 22-year period (2000–2022).
The highest eradication rates for initial treatment were observed with concomitant therapy (PPI/amoxicillin/clarithromycin/metronidazole; PACM-14) at 89.8% and bismuth quadruple therapy (PPI/bismuth/metronidazole/tetracycline; PBMT-14) at 89.3%. Both regimens maintained stable effectiveness over time. In contrast, all salvage regimens demonstrated reduced efficacy, though PBMT-14 remained the most effective (69.3%).
Prior antibiotic exposure affected treatment success. Patients with a history of macrolide use had lower eradication with PACM-14 (adjusted odds ratio [aOR], 0.68; 95% CI, 0.60–0.77), while prior metronidazole use reduced PBMT-14 efficacy (aOR, 0.61; 95% CI, 0.50–0.75). Repeat use of the same regimen for salvage treatment significantly decreased the likelihood of eradicating H pylori (PACM-14: aOR, 0.46; 95% CI, 0.35–0.61; PBMT-14: aOR, 0.51; 95% CI, 0.39–0.67).
Concomitant and bismuth quadruple regimens were the most effective initial empiric therapies for H. pylori in a diverse U.S. community setting. PBMT-14 also proved most effective for salvage therapy. Clinicians should avoid reusing prior regimens and consider patients’ antibiotic histories—especially prior macrolide or metronidazole use—when selecting therapy.
Reference:
Merchant SA, Badalov JM, Shah SC, Corley DA, Li D. Comparative effectiveness of empiric treatment for Helicobacter pylori in a large, diverse population in the United States. Clin Gastroenterol Hepatol. Published online July 14, 2025.
