bismuth subcitrate potassium/ metronidazole/tetracycline / Generic mfg. - LARVOL DELTA

Assessing Helicobacter pylori Testing and Treatment by Providers at an Academic Tertiary Medical Center: A Quality Improvement Project (ACG 2025) - "To assess baseline knowledge, in 2018 we performed an IRB approved survey of primary care and GI providers and found 20% were considering serology as a diagnostic option, 50% were treating asymptomatic patients with HPI, 15% were primarily treating with PPI-Bismuth-Metronidazole-Tetracycline (PBMT), 38% were always checking for eradication and 98% said local resistance information for HPI would be helpful. 108 providers participated in the re-assessment survey (Table 1). Key results include that 8% of providers are using serology for diagnosis, 69% are treating asymptomatic patients with HPI, 81% primarily prescribe PBMT and 78% always tested for eradication (Table 2). 14 % of providers are primarily prescribing PPI-amoxicillin-clarithromycin (PAC). Compared to 2018, 5 times more providers are primarily prescribing PBMT and almost 2 times more are consistently testing for eradication, likely as a result of updated national guidelines and local educational and..."

Infectious Disease • Pediatrics

Comparative Effectiveness of Empiric Treatment for Helicobacter pylori in a Large, Diverse Population in the United States. (PubMed, Clin Gastroenterol Hepatol) - "In a large, community-based U.S. population, concomitant and bismuth-quadruple therapies had the highest eradication rates for H. pylori for initial treatment without a substantial decline in efficacy over time, while bismuth quadruple was the most successful salvage regimen. History of macrolides or metronidazole use should be reviewed to inform treatment selection. Repeat use of previously prescribed regimens should be avoided."

HEOR • Journal • Infectious Disease

Investigating the Effect of eradication of Helicobacter Pylori Infection in Controlling Blood Sugar in Diabetic Patients. (PubMed, Arch Razi Inst) - "In this experimental study, 61 type II diabetic patients with or without dyspepsia symptoms, in whom Helicobacter pylori infection was proven by anti-Helicobacter pylori IgG serological method, were treated with four anti-Helicobacter pylori drug regimens (bismuth+ metronidazole) +tetracycline + omeprazole. It was concluded that a positive relationship exists between the eradication effect of Helicobacter pylori and blood sugar control (reduction of HbAlC). However, further studies in diabetic patients are recommended to obtain more accurate results."

Journal • Diabetes • Dyspepsia • Infectious Disease • Metabolic Disorders • Type 2 Diabetes Mellitus

VONOPRAZAN IS HIGHLY EFFECTIVE AND SAFE AS AN ADJUVANT IN DIFFERENT REGIMES IN FIRST- AND RESCUE-LINE THERAPIES FOR H. PYLORI INFECTION IN BRAZIL (DDW 2025) - "The regimens reaching 90% eradication were: dual-VPZ+amoxicillin for first-line and rescue treatments (96% and 100%, respectively), quadruple VPZ+bismuth+tetracycline+metronidazole for second- and third-line treatments (92% and 90% respectively), and quadruple PPI+bismuth+levofloxacin+amoxicillin (100%) for second-line treatment (Table and Figure). VPZ, when prescribed as an adjuvant for treating H. pylori infection, shows highly effective results as part of dual therapy with amoxicillin for first-line and rescue treatments, as well as in quadruple therapy with bismuth+metronidazole+ tetracycline or bismuth+amoxycillin and rifabutin for rescue treatments."

Clinical • Dyspepsia • Gastric Cancer • Gastroenterology • Infectious Disease • Peptic Ulcer

Tailored Vs. Empirical Helicobacter Pylori Infection Treatment (clinicaltrials.gov) - P4 | N=160 | Not yet recruiting | Sponsor: Manuel Coelho da Rocha | Trial completion date: Nov 2025 ➔ Dec 2026 | Trial primary completion date: Jun 2025 ➔ Sep 2026

Trial completion date • Trial primary completion date • Infectious Disease

THE INFLUENCE OF INDICATIONS FOR HELICOBACTER PYLORI INVESTIGATION ON PRESCRIPTIONS AND EFFECTIVENESS: EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG) (UEGW 2024) - "The effectiveness with PPI-bismuth-metronidazole-tetracycline (quadruple-BMTc) was lower in patients treated for non-investigated dyspepsia as compared to those with dyspepsia with normal endoscopy, however, in all cases cure rates were optimal (91.8% vs. 93.9%, p= 0.047)...Concomitant clarithromycin-amoxicillin-tinidazole/metronidazole (CAT-CAM) achieved 90% except in patients with non-investigated dyspepsia... In Europe, indications for H. pylori investigation could be improved in 5.6% of patients. Higher effectiveness was observed in patients treated for gastric or duodenal ulcers and preneoplastic lesions. Bismuth and non-bismuth quadruple therapies reached optimal results in almost all indications."

Dyspepsia • Gastric Cancer • Gastroenterology • Gastroesophageal Reflux Disease • Infectious Disease • Oncology • Peptic Ulcer

Indications of Helicobacter pylori Eradication Treatment and Its Influence on Prescriptions and Effectiveness (Hp-EuReg). (PubMed, Helicobacter) - P=N/A | "In Europe, patients with gastric or duodenal ulcers and preneoplastic lesions showed higher H. pylori treatment effectiveness. Bismuth and non-bismuth quadruple therapies achieved optimal results in almost all indications."

Journal • Dyspepsia • Gastric Cancer • Gastroenterology • Gastroesophageal Reflux Disease • Infectious Disease • Oncology • Peptic Ulcer

Real-world efficacy of second-line therapies for Helicobacter pylori: a population-based study. (PubMed, J Antimicrob Chemother) - "Bismuth quadruple therapy was the most effective second-line regimen for H. pylori in this real-world study. Despite a very low success rate, clarithromycin-containing triple therapies were still commonly used as second-line regimens."

Journal • Real-world • Real-world effectiveness • Real-world evidence • Infectious Disease

Success of Helicobacter pylori Guideline-based Treatment of Newly Diagnosed and Previously Treated Patients During 2007-2021 in Edmonton, Alberta. (PubMed, J Can Assoc Gastroenterol) - "Updated 2016 Helicobacter pylori consensus guidelines recommend treatment for 14 days with concomitant therapy (proton-pump inhibitor (PPI)-amoxicillin-metronidazole-clarithromycin (PAMC) or bismuth-based quadruple therapy (PPI-bismuth-metronidazole-tetracycline, PBMT)) as first line, PBMT or PPI-amoxicillin-levofloxacin (PAL) as second or third line, and PPI-amoxicillin-rifabutin (PAR) as fourth line for 10 days. PAR therapy shows suboptimal cure rates (50-57% success) but can be considered as third instead of fourth line given increasing levofloxacin resistance rates. Antibiotic resistance in H. pylori is common to clarithromycin, metronidazole, and levofloxacin and frequently accounts for treatment failures."

Journal • Infectious Disease

The second Irish Helicobacter pylori Working Group consensus for the diagnosis and treatment of Helicobacter pylori infection in adult patients in Ireland. (PubMed, Eur J Gastroenterol Hepatol) - "These recommendations are intended to provide the most relevant current best-practice guidelines for the management of H. pylori infection in adults in Ireland."

Journal • Infectious Disease

INCIDENCE AND PREDICTORS OF C. DIFFICILE INFECTION AFTER HELICOBACTER PYLORI TREATMENT IN A LARGE, COMMUNITY-BASED U.S. POPULATION (DDW 2024) - "59) PPI/bismuth/metronidazole/tetracycline (PBMT) while PPI/amoxicillin/clarithromycin (aOR 0. In a large community-based U. S. population treatment of HP was associated with an increased risk of CDI compared with no treatment although the incidence was very low. The increased risk was primarily associated with quadruple or metronidazole-based HP treatment regimens. History of IBD or prior CDI was the strongest predictor of CDI after HP treatment."

Clinical • Gastric Cancer • Gastroenterology • Gastrointestinal Cancer • Gastrointestinal Disorder • Hematological Disorders • Immunology • Infectious Disease • Inflammatory Bowel Disease • Oncology • Peptic Ulcer • Solid Tumor

Tailored vs. Empirical Helicobacter Pylori Infection Treatment (clinicaltrials.gov) - P4 | N=160 | Not yet recruiting | Sponsor: Manuel Coelho da Rocha | Trial completion date: Apr 2025 ➔ Nov 2025 | Initiation date: Feb 2024 ➔ Sep 2024 | Trial primary completion date: Nov 2024 ➔ Jun 2025

Trial completion date • Trial initiation date • Trial primary completion date • Infectious Disease

Helicobacter pylori Secondary Antibiotic Resistance after One or More Eradication Failure: A Genotypic Stool Analysis Study. (PubMed, Antibiotics (Basel)) - "Resistance to clarithromycin, amoxicillin, metronidazole, levofloxacin, and tetracycline was assessed using a high-resolution melting curve. The only tetracycline-resistant patient had received Pylera. In conclusion, our data seem to show that, even though secondary resistance is not very high, resistance to clarithromycin could be very likely related to previous exposure to this antibiotic."

Journal • Infectious Disease

Tailored vs. Empirical Helicobacter Pylori Infection Treatment (clinicaltrials.gov) - P4 | N=160 | Not yet recruiting | Sponsor: Manuel Coelho da Rocha

New P4 trial • Infectious Disease

Role of proton pump inhibitors dosage and duration in Helicobacter pylori eradication treatment: Results from the European Registry on H. pylori management. (PubMed, United European Gastroenterol J) - "We recommend, in first-line treatment, the use of high-dose PPIs in 14-day triple therapy and in 10-or 14-day quadruple concomitant therapy in first-line treatment, while standard-dose PPIs would be sufficient in 10-day bismuth quadruple therapies. On the other hand, in second-line treatment, high-dose PPIs would be more beneficial in 14-day triple therapy with levofloxacin and amoxicillin or in 10-day bismuth quadruple therapy either as a three-in-one single capsule or in the traditional scheme."

Journal • Gastroenterology • Infectious Disease

Real-world practice of Helicobacter pylori management: A survey among physicians in Southeast Asia. (PubMed, Helicobacter) - "Choosing inappropriate regimens containing antibiotics with high resistance rates is not uncommon in Southeast Asia, especially among non-GI physicians. In countries with high clarithromycin resistance, the PBMT regimen is underutilized."

Journal • Real-world • Real-world evidence • Gastroenterology • Infectious Disease

Bismuth-Based Therapy: The New Therapy for Obese Patients Undergoing Gastric Bypass Surgery? (PubMed, Obes Surg) - "Ten days of BQT did achieve Maastricht V/Florence recommended first-line eradication rates (at least 80%) in obese Portuguese patients undergoing Roux-en Y gastric bypass, being by now the most reliable choice for Hp eradication."

Bariatric surgery • Journal • Surgery • Genetic Disorders • Infectious Disease • Obesity

Bismuth quadruple three-in-one single capsule three times a day increases effectiveness compared with the usual four times a day schedule: results from the European Registry on Helicobacter pylori Management (Hp-EuReg). (PubMed, Gut) - "ScBQT prescribed three times a day was more effective than the traditional four times a day schedule. No differences were observed in treatment adherence or safety."

Journal • Gastroenterology • Infectious Disease • Peptic Ulcer

Current Trends in the Management of Helicobacter pylori Infection in Serbia: Preliminary Results from the European Registry on H. pylori Management. (PubMed, Dig Dis) - "Considering the high eradication rate, 14-day non-bismuth quadruple concomitant therapy is a reasonable first-line choice, while quinolone-based therapy and single-capsule Pylera® should be considered as rescue therapy options."

Journal • Dyspepsia • Infectious Disease

REFRACTORY MUCOSAL INFECTIONS IN A XLA PATIENT (ESPID 2023) - "Esophagogastroduodenoscopy revealed erosive pangastritis and histopathology chronic superficial gastritis with focal intestinal metaplasia associated with Helicobacter pylori (positive culture and RT-PCR) and presence of a mutation in the 23S rDNA gene associated with clarithromycin resistance...He underwent treatment with amoxicillin + levofloxacin + PPI. 3 months later, a positive breath test led to a new eradication with PPI + amoxicillin + metronidazol + rifabutin and concomitantly IgG 1 g/kg for 5 days. He maintained symptoms and persistence of H. pylori erosive gastritis in EGD and underwent rescue therapy with PPI + bismuth + metronidazole + tetracycline with success. Learning Points/ Mucosal infections are very difficult to resolve in XLA patients even with adequate IgG replacement therapy. These patients lack mucosal antibodies, very important to control infection."

Clinical • Cognitive Disorders • Conjunctivitis • Gastrointestinal Disorder • Immunology • Infectious Disease • Ocular Infections • Ocular Inflammation • Ophthalmology • Otorhinolaryngology • Pediatrics • Pneumonia • Primary Immunodeficiency • Respiratory Diseases • BTK • CD19

PRACTICE PATTERNS AND COMPARATIVE EFFECTIVENESS OF HELICOBACTER PYLORI TREATMENT REGIMENS OVER 20 YEARS IN A LARGE, DIVERSE, COMMUNITY-BASED U.S. POPULATION (DDW 2023) - "The most commonly prescribed regimens were proton pump inhibitor (PPI)/amoxicillin/clarithromycin (PAC) (44.0%), PPI/bismuth/metronidazole/tetracycline (PBMT) (36.3%), PPI/amoxicillin/clarithromycin/metronidazole (PACM) (10.5%), PPI/clarithromycin/metronidazole (PCM) (6.5%), PPI/amoxicillin/metronidazole (PAM) (1.8%), and PPI/amoxicillin/levofloxacin (PAL) (0.5%). In a large, diverse, community-based U.S. population, commonly used H. pylori treatment regimens were highly effective in eradicating H. pylori , although effectiveness decreased substantially after each round of treatment. More than one-third of individuals received the same regimen after the first-time treatment. Overall, quadruple therapies had higher success rates than triple therapies, and amoxicillin-containing regimens had higher success rates compared to clarithromycin or levofloxacin-containing regimens."

Clinical • HEOR • Infectious Disease

"Se pueden tomar probióticos durante el tratamiento con Pylera? Gracias" (@Juan12JJ)

Endo Launches First Generic Version of Pylera (bismuth subcitrate potassium, metronidazole, tetracycline hydrochloride) Capsules (Canada Newswire) - "Endo International plc...announced today that one of its operating companies, Par Pharmaceutical, Inc., has begun shipping the first generic version of Allergan's Pylera® (bismuth subcitrate potassium, metronidazole, tetracycline hydrochloride) 140 mg, 125 mg and 125 mg capsules in the U.S., following final approval from the U.S. Food and Drug Administration of its Abbreviated New Drug Application."

Generic launch • Gastroenterology • Infectious Disease • Peptic Ulcer

Third-line and rescue therapy for refractory Helicobacter pylori infection: A systematic review. (PubMed, World J Gastroenterol) - "We recommend sitafloxacin-based triple therapy containing vonoprazan in regions with low macrolide resistance profile. In regions with known resistance to macrolides or unavailability of bismuth, rifabutin-based triple therapy is recommended."

Clinical • Journal • Review • Infectious Disease

Empirical rescue treatment of Helicobacter pylori infection in third and subsequent lines: 8-year experience in 2144 patients from the European Registry on H. pylori management (Hp-EuReg). (PubMed, Gut) - P=N/A | "Empirical rescue treatment in third and subsequent lines achieved suboptimal effectiveness in most European regions. Only quadruple bismuth-metronidazole-tetracycline (10-day single-capsule or 14-day traditional scheme) and triple amoxicillin-levofloxacin therapies reached acceptable outcomes in some settings. Compliance with empirical therapy optimisation principles is still poor 5 years after clinical practice guidelines update."

Journal • Gastroenterology • Infectious Disease