Patterns of quadruple therapy use including bismuth for Helicobacter pylori eradication: A cohort study in the French national claims database

Therapie. Sep-Oct 2021;76(5):435-440. doi: 10.1016/j.therap.2020.09.002. Epub 2020 Sep 25.


Background: Quadruple therapy using a single capsule formulation of bismuth, metronidazole and tetracycline (BMT; Pylera®), associated with omeprazole for the eradication of Helicobacter pylori, represents the reintroduction of bismuth in France after 40 years.

Objective: To describe the real-life patterns of use of BMT following a request from the French health authorities.

Methods: Patients with a first BMT dispensing (index date, ID), with one year of data before and after ID, were identified in the French nationwide claims database 1/97 sample. Misuse of BMT was defined as dispensing>1 pack of BMT at ID or absence of a diagnostic test in the preceding year.

Results: In total, 540 patients were included. Prescribers were gastroenterologists (n=243; 45%) and general practitioners (n=160; 30%). A proton pump inhibitor was co-dispensed to 504 patients (96%). Ten patients (2%) had contraindications to BMT. Fifty-nine patients (11%) met the misuse criteria: ten (2%) were dispensed>1 pack of BMT and 49 (9%) had not had a diagnostic test for H. pylori in the previous year. During follow-up, 27 patients (5%) required retreatment (treatment failure).

Conclusion: In this real-life study, most patients were dispensed only one pack of BMT, consistent with recommendations. Misuse related principally to the absence of prior diagnostic test for H. pylori.

Keywords: Bismuth; France; Helicobacter pylori; Metronidazole; Misuse; Pharmacoepidemiology; Tetracycline.

MeSH terms

  • Bismuth / therapeutic use
  • Cohort Studies
  • Drug Therapy, Combination
  • Helicobacter Infections* / drug therapy
  • Helicobacter Infections* / epidemiology
  • Helicobacter pylori*
  • Humans
  • Treatment Outcome


  • Bismuth