Clarithromycin sustained-release tablets may be improper therapy for the eradication of Helicobacter pylori

BACKGROUND: Clarithromycin plays a notable role in the eradication of Helicobacter pylori (H. pylori) through the quadruple therapy. However, there is limited research on whether different dosage forms of clarithromycin yield similar efficacy against H. pylori. This study aimed to evaluate the effectiveness of different dosage forms of clarithromycin in the bismuth-containing quadruple therapy for eradicating H. pylori. METHODS: A retrospective analysis was conducted on patients diagnosed with H. pylori infection through the 13C-urea breath test (13C-UBT) at Henan Provincial People’s Hospital (China) from 2020 to 2022. These patients received treatment with either clarithromycin dispersible tablets or clarithromycin sustained-release tablets (each at 500 mg). Treatment efficacy was assessed using a 13C-UBT at least four weeks after completion of treatment. Eradication rate was investigated as the primary outcome, and influencing factors between the eradication rate of H. pylori was analyzed. RESULTS: In the dispersible and sustained-release tablets groups, univariate analysis revealed a lower eradication rate with the clarithromycin sustained-release tablets regimen compared with the clarithromycin dispersible tablets regimen (75.26% (73/97) vs. 95.26% (200/210), P < 0.05). Other factors, such as smoking, age were not significantly associated with cure rate. Multivariate analysis identified the dosage forms of clarithromycin as an independent risk factor for eradication failure of the bismuth-containing quadruple therapy (odds ratio = 0.145, 95% confidence interval: (0.065-0.323); P < 0.05). CONCLUSION: The clarithromycin dispersible tablets therapy demonstrated a higher eradication rate for H. pylori infection. KEYWORDS: Helicobacter pylori;bismuth-containing quadruple regimen; clarithromycin ; triple plus bismuth therapy ;eradication failure