Standard-Dose Regimens Achieve High Eradication Rates in H. pylori Treatment
Escalating antibiotic or bismuth doses does not improve Helicobacter pylori eradication rates, according to an analysis of a large European registry evaluating real-world treatment effectiveness across dosing strategies. The findings support adherence to standard dosing and highlight other factors as more influential for treatment success.
Investigators analyzed data from the Hp-EuReg registry, including 10,767 first-line treatment records and 2,952 second- to sixth-line regimens collected between 2013 and 2024. The study evaluated multiple bismuth-containing quadruple therapies, assessing effectiveness using a modified intention-to-treat analysis.
Several first-line regimens achieved high eradication rates when standard dosing thresholds were met. The clarithromycin-amoxicillin-bismuth (CAB) regimen exceeded 90% effectiveness with standard doses of clarithromycin (1,000 mg/day) and amoxicillin (2,000 mg/day), regardless of bismuth dose. Similarly, the bismuth-metronidazole-tetracycline (BMTc) regimen reached more than 90% effectiveness when tetracycline was at least 1,500 mg/day, metronidazole 1,500 mg/day, and bismuth at least 480 mg/day.
Across regimens, increasing bismuth or antibiotic doses beyond these thresholds did not improve outcomes. The authors reported that “increasing antibiotic or bismuth doses above the standard did not improve effectiveness of H. pylori treatment.” In later-line therapies, eradication rates were lower overall, with all regimens achieving less than 90% effectiveness and showing no benefit from higher dosing.
The analysis also found that increasing doses of specific agents, including levofloxacin in the amoxicillin-levofloxacin-bismuth regimen, did not enhance treatment success.
The authors concluded that factors such as “adherence, treatment length, and proton pump inhibitor co-therapy may be more impactful than escalation of antibiotics/bismuth doses.”
Reference
Ramai, Daryl, et al. Interventions for increasing colorectal cancer screening uptake: A systematic review and network meta-analysis. Gastroenterology. https://doi.org/10.1053/j.gastro.2026.02.047.
