Efficacy of 7-Day and 14-Day Bismuth-Containing Quadruple Therapy and 7-Day and 14-Day Moxifloxacin-Based Triple Therapy as Second-Line Eradication for Helicobacter pylori Infection

Gut Liver. 2015 Jul;9(4):478-85. doi: 10.5009/gnl14020.


Background/aims: Bismuth-containing quadruple and moxifloxacin-based triple regimens are recommended as second-line therapy for Helicobacter pylori infection. The aim of this study was to compare the efficacy of each regimen.

Methods: From August 2004 to October 2012, a total of 949 patients (mean age, 54.32±12.08 years; male, 49.4%) who failed H. pylori eradication with a standard triple regimen were included. Patients treated with a bismuth-containing quadruple regimen for 7 and 14 days were designated as 7-BMT and 14-BMT, respectively, and those treated with a moxifloxacin-based triple regimen for 7 and 14 days were designated as 7-MA and 14-MA, respectively. H. pylori eradication was confirmed using the (13)C-urea breath test, rapid urease test or histology.

Results: The eradication rates by 7-BMT, 14-BMT, 7-MA, and 14-MA were 66.4% (290/437), 71.1% (113/159), 53.1% (51/96), and 73.5% (189/257), respectively, by intention-to-treat analysis (ITT) and 76.5% (284/371), 83.8% (109/130), 55.6% (50/90), and 80.6% (187/232), respectively, by per-protocol analysis (PP). The eradication rates were higher in 14-BMT than 7-BMT by the ITT and PP analyses (p=0.277 and p=0.082, respectively). The 14-BMT and 14-MA treatments showed similar efficacies by ITT and PP (p=0.583 and p=0.443, respectively).

Conclusions: The 7-BMT, 14-BMT, and 14-MA treatments showed similar and suboptimal efficacies. In both regimens, extending the duration of treatment may be reasonable considering the high level of antibiotic resistance in Korea.

Keywords: Bismuth-containing quadruple regimen; Helicobacter pylori; Moxifloxacin-based triple regimen; Second-line therapy.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Amoxicillin / administration & dosage
  • Antacids / administration & dosage*
  • Anti-Infective Agents / administration & dosage*
  • Bismuth / administration & dosage*
  • Drug Administration Schedule
  • Drug Therapy, Combination / methods
  • Female
  • Fluoroquinolones / administration & dosage*
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori*
  • Humans
  • Intention to Treat Analysis
  • Male
  • Metronidazole / administration & dosage
  • Middle Aged
  • Moxifloxacin
  • Proton Pump Inhibitors / administration & dosage
  • Retrospective Studies
  • Tetracycline / administration & dosage
  • Treatment Outcome


  • Antacids
  • Anti-Infective Agents
  • Fluoroquinolones
  • Proton Pump Inhibitors
  • Metronidazole
  • Amoxicillin
  • Tetracycline
  • Bismuth
  • Moxifloxacin