Bismuth-containing quadruple therapy associated with higher H. pylori eradication rates compared to triple therapy in children.

This retrospective cohort study evaluated 161 pediatric patients diagnosed with Helicobacter pylori infection. Participants were treated with either 14-day bismuth-containing quadruple therapy comprising proton pump inhibitor, clarithromycin, amoxicillin, and colloidal bismuth subcitrate or 14-day triple therapy comprising proton pump inhibitor, clarithromycin, and amoxicillin.

The primary outcome assessed eradication rates via 13C-urea breath test 4 weeks post-treatment. Results showed eradication rates were significantly higher in the bismuth-containing quadruple therapy group at 90.36% compared to 74.36% (P = 0.007). Additionally, bismuth-containing quadruple therapy was identified as a protective factor against eradication failure with an adjusted OR of 0.351 (P = 0.018).

Secondary outcomes included symptom scores and safety. Abdominal pain scores improved more markedly with quadruple therapy (0.68 vs 0.85), though P > 0.05. A similar safety profile was reported between groups. Serious adverse events and discontinuations were not reported. Changes in bloating and nausea scores were also assessed but not detailed in the results.

As an observational study, causal inference is limited regarding the intervention. Follow-up duration was 4 weeks post-treatment. These findings suggest potential benefit but require confirmation in randomized trials before widespread adoption in clinical practice. Clinicians should weigh the higher eradication rate against potential side effects and the observational nature of the data.