Abstract: Background & aim: This study aimed to compare the efficacy and safety of bismuth-included standard regimen and modified sequential treatments in Turkey, where the success rate of standard triple therapy is very low.Methods: One-hundred and sixty patients with dyspeptic complaints and naïve Helicobacter pylori infection were randomized into four groups: 41 patients received standard 14-day quadruple treatment (STD) (Rabeprazole 20mg-bid, bismuth subcitrate (120mg-qid), Tetracycline 500mg-qid, Metronidazole 500mg-tid) for 2weeks. The modified sequential therapy groups received 20mg rabeprazole and 1g amoxicillin, twice daily for the first 5days, followed by Rabeprazole 20mg-bid, bismuth subcitrate (120mg-qid), Tetracycline 500mg-qid, Metronidazole 500mg-tid for the remaining 5 (10day sequential therapy group-10S) (42 patients), 7 (12day sequential therapy group-12S) (42 patients) and 9 (14day sequential therapy group-14S) (41 patients) days.Results: The overall compliance and H. pylori eradication rate among the 160 patients who completed the H. pylori eradication regimens were 86.9% (139/160) and 78.1% (125/160), respectively. The results were not statistically different between groups in the eradication rates. Per-protocol eradication rates were 76.5% in STD, 71.4% in 10S, 82.4% in 12S and 83.3% in 14S groups (p=0.7). Intention-to-treatment rates were 77.5% in STD, 72.5% in 10S, 82.5% in 12S and 80.0% in 14S groups (p=0.5).Conclusion: The eradication rates of standard 14-day and different sequential quadruple treatment regimens are comparable and much more higher than with standard 14-day triple H. pylori eradication treatment that has been reported previously in Turkey.
