Efficacy assessment of diverse antibiotic combinations in bismuth quadruple regimens and risk factors for Helicobacter pylori eradication: a retrospective single-center study in China

Objectives: To evaluate the efficacy of various antibiotic combinations in bismuth quadruple therapy for H. pylori eradication. Methods: This study involved a retrospective analysis of data collected from a single medical center in Beijing, China. A cohort of patients was enrolled with H. pylori infection that underwent 14-d bismuth quadruple therapy (antibiotics, omeprazole, and bismuth) and received a test for cure between January 2020 and December 2023. Patient demographics and therapeutic regimens were meticulously compiled and subsequently categorized into five groups based on antibiotic combinations used: amoxicillin-clarithromycin, amoxicillin-levofloxacin, amoxicillin-doxycycline, clarithromycin-levofloxacin, and clarithromycin-doxycycline. The eradication rates were then calculated and compared across these distinct regimens. Results: This study evaluated a cohort of 575 patients, comprising 261 males and 314 females. A significant majority of patients, 76.3% (n=439), received a treatment regimen comprising amoxicillin and clarithromycin. The amoxicillin-levofloxacin combination was administered to 8.5% (n=49) of the patients. A smaller proportion, 1.7% (n=10), were treated with an amoxicillin-doxycycline regimen. Furthermore, 8.9% (n=51) of the patients received a clarithromycin-levofloxacin regimen, while 4.5% (n=26) were treated with a combination of clarithromycin and doxycycline. Patients treated with the amoxicillin-doxycycline-based regimen exhibited significantly higher eradication rates than other regimens (70.0% vs 65.4%, 32.7%, 54.9%, and 42.3%, respectively; P=0.001). Furthermore, the results indicated that risk factors such as smoking and alcohol consumption had a significant impact on the eradication rates (all P<0.01). Conclusion: This study reveals significant differences in the eradication rates of various antibiotic combinations for H. pylori infection. Of particular note is that the amoxicillin-doxycycline-based regimen outperformed other antibiotic combinations, with a considerably higher eradication rate. This provides vital insight to inform clinical decision-making in the treatment of H. pylori.