{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:33:19Z","timestamp":1787758399635,"version":"build-2784847793"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,7]]},"abstract":"\n Introduction:<\/jats:title>\n \n Helicobacter pylori<\/jats:italic>\n -induced chronic infection is associated with peptic ulcer, chronic gastritis, gastric cancer, and increasing antibiotic resistance. We aimed to evaluate the efficacy of clarithromycin-based triple therapy and non-bismuth based quadruple therapy for eradicating\n H. pylori<\/jats:italic>\n in patients with chronic gastritis in Kuwait.\n <\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n We enrolled a total of 603 treatment-naive dyspeptic patients with gastric biopsy-proven chronic gastritis secondary to\n H. pylori<\/jats:italic>\n in a prospective, open-label, randomized study. Patients were randomized into two groups: a group received the standard triple therapy (omeprazole, amoxicillin, and clarithromycin) for 14 days and a group received quadruple therapy (omeprazole, amoxicillin, clarithromycin, and metronidazole) for 14 days. All patients were tested for the eradication of\n H. pylori<\/jats:italic>\n by carbon-13 urea breath test 1 month after eradication therapy.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n The overall eradication rate was 63.2%. The eradication rates in intention-to-treat (ITT) and per protocol (PP) population were 58.4% and 64.6%, respectively, in triple therapy group. In the quadruple therapy group, the eradication rates in ITT and PP population were 68.0% and 78.5%, respectively, with a statistically significant higher eradication rate in patients treated by quadruple therapy than the triple therapy (\n P<\/jats:italic>\n < 0.01). Multivariate logistic regression analysis revealed that treatment regimen was the only significant predictor for successful\n H. pylori<\/jats:italic>\n eradication. The most common adverse events were abnormal taste, headache, dizziness, and abdominal pain.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n \n Non-bismuth based quadruple therapy is more effective than standard clarithromycin-based triple therapy for eradicating\n H. pylori<\/jats:italic>\n in patients with chronic gastritis.\n <\/jats:p>\n ClinicalTrials.gov Identifier: NCT04617613<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/jgid.jgid_13_22","type":"journal-article","created":{"date-parts":[[2022,8,26]],"date-time":"2022-08-26T06:43:02Z","timestamp":1661496182000},"page":"99-105","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["A Randomized Clinical Trial Comparing Triple Therapy versus Non-bismuth based Quadruple Therapy for the Eradication of Helicobacter Pylori in Kuwait"],"prefix":"10.4103","volume":"14","author":[{"given":"Ahmad","family":"Alfadhli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Alboraie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa","family":"Afifi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhijit","family":"Dangi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-3-20240828","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1523-5378.2010.00779.x","article-title":"Epidemiology of Helicobacter pylori infection and public health implications","volume":"15","author":"Ford","year":"2010","journal-title":"Helicobacter"},{"key":"R2-3-20240828","doi-asserted-by":"crossref","first-page":"2292","DOI":"10.1007\/s10620-006-9210-5","article-title":"Helicobacter pylori infection and gender: A meta-analysis of population-based prevalence surveys","volume":"51","author":"de Martel","year":"2006","journal-title":"Dig Dis Sci"},{"key":"R3-3-20240828","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1136\/gut.35.6.742","article-title":"Importance of childhood socioeconomic status on the current prevalence of Helicobacter pylori infection","volume":"35","author":"Malaty","year":"1994","journal-title":"Gut"},{"key":"R4-3-20240828","first-page":"299","article-title":"Helicobacter pylori in developing countries. World Gastroenterology Organisation Global Guideline","volume":"20","author":"Hunt","year":"2011","journal-title":"J Gastrointestin Liver Dis"},{"key":"R5-3-20240828","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/1471-230X-10-14","article-title":"Prevalence of Helicobacter pylori infection among new outpatients with dyspepsia in Kuwait","volume":"10","author":"Alazmi","year":"2010","journal-title":"BMC Gastroenterol"},{"key":"R6-3-20240828","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1080\/14786419.2010.501763","article-title":"In vitro antibacterial activity of some Iranian medicinal plant extracts against Helicobacter pylori","volume":"25","author":"Hajimahmoodi","year":"2011","journal-title":"Nat Prod Res"},{"key":"R7-3-20240828","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1136\/gutjnl-2012-302084","article-title":"Management of Helicobacter pylori infection \u2013 The maastricht IV\/florence consensus report","volume":"61","author":"Malfertheiner","year":"2012","journal-title":"Gut"},{"key":"R8-3-20240828","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1136\/gutjnl-2016-312288","article-title":"Management of Helicobacter pylori infection-the Maastricht V\/Florence Consensus Report","volume":"66","author":"Malfertheiner","year":"2017","journal-title":"Gut"},{"key":"R9-3-20240828","first-page":"27","article-title":"Gastric MALT lymphoma: Old and new insights","volume":"27","author":"Zullo","year":"2014","journal-title":"Ann Gastroenterol"},{"key":"R10-3-20240828","doi-asserted-by":"crossref","first-page":"2621","DOI":"10.1111\/j.1572-0241.2003.08724.x","article-title":"An update of the Cochrane systematic review of Helicobacter pylori eradication therapy in nonulcer dyspepsia: Resolving the discrepancy between systematic reviews","volume":"98","author":"Moayyedi","year":"2003","journal-title":"Am J Gastroenterol"},{"key":"R11-3-20240828","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/0300-1652.108884","article-title":"Helicobacter pylori eradication therapy: A review of current trends","volume":"54","author":"Olokoba","year":"2013","journal-title":"Niger Med J"},{"key":"R12-3-20240828","doi-asserted-by":"crossref","first-page":"668","DOI":"10.3748\/wjg.v10.i5.668","article-title":"Low eradication rate of Helicobacter pylori with triple 7-14 days and quadriple therapy in Turkey","volume":"10","author":"Gumurdulu","year":"2004","journal-title":"World J Gastroenterol"},{"key":"R13-3-20240828","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1136\/gut.2003.022111","article-title":"H pylori antibiotic resistance: Prevalence, importance, and advances in testing","volume":"53","author":"M\u00e9graud","year":"2004","journal-title":"Gut"},{"key":"R14-3-20240828","doi-asserted-by":"crossref","first-page":"556","DOI":"10.5009\/gnl15470","article-title":"Sequential therapy versus triple therapy for the first line treatment of Helicobacter pylori in Korea: A nationwide randomized trial","volume":"10","author":"Kim","year":"2016","journal-title":"Gut Liver"},{"key":"R15-3-20240828","doi-asserted-by":"crossref","first-page":"94","DOI":"10.7326\/0003-4819-144-2-200601170-00006","article-title":"Clarithromycin-resistant genotypes and eradication of Helicobacter pylori","volume":"144","author":"De Francesco","year":"2006","journal-title":"Ann Intern Med"},{"key":"R16-3-20240828","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1136\/gutjnl-2015-309252","article-title":"Kyoto global consensus report on Helicobacter pylori gastritis","volume":"64","author":"Sugano","year":"2015","journal-title":"Gut"},{"key":"R17-3-20240828","doi-asserted-by":"crossref","first-page":"e12395","DOI":"10.1111\/hel.12395","article-title":"Randomized controlled study of a novel triple nitazoxanide (NTZ)-containing therapeutic regimen versus the traditional regimen for eradication of Helicobacter pylori infection","volume":"22","author":"Shehata","year":"2017","journal-title":"Helicobacter"},{"key":"R18-3-20240828","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1046\/j.1365-2036.2000.00744.x","article-title":"A meta-analysis of short versus long therapy with a proton pump inhibitor clarithromycin and either metronidazole or amoxycillin for treating Helicobacter pylori infection","volume":"14","author":"Calvet","year":"2000","journal-title":"Aliment Pharmacol Ther"},{"key":"R19-3-20240828","doi-asserted-by":"crossref","first-page":"553","DOI":"10.7326\/0003-4819-147-8-200710160-00008","article-title":"Meta-analysis: Duration of first-line proton-pump inhibitor based triple therapy for Helicobacter pylori eradication","volume":"147","author":"Fuccio","year":"2007","journal-title":"Ann Intern Med"},{"key":"R20-3-20240828","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1016\/S0140-6736(07)61455-X","article-title":"Sequential regimens for Helicobacter pylori eradication","volume":"370","author":"Moayyedi","year":"2007","journal-title":"Lancet"},{"key":"R21-3-20240828","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1136\/gut.2007.125658","article-title":"The sequential therapy regimen for Helicobacter pylori eradication: A pooled-data analysis","volume":"56","author":"Zullo","year":"2007","journal-title":"Gut"},{"key":"R22-3-20240828","doi-asserted-by":"crossref","first-page":"923","DOI":"10.7326\/0003-4819-148-12-200806170-00226","article-title":"Meta-analysis: Sequential therapy appears superior to standard therapy for Helicobacter pylori infection in patients naive to treatment","volume":"148","author":"Jafri","year":"2008","journal-title":"Ann Intern Med"},{"key":"R23-3-20240828","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/j.1365-2710.2008.00969.x","article-title":"Sequential therapy vs. standard triple therapies for Helicobacter pylori infection: A meta-analysis","volume":"34","author":"Tong","year":"2009","journal-title":"J Clin Pharm Ther"},{"key":"R24-3-20240828","doi-asserted-by":"crossref","first-page":"3069","DOI":"10.1038\/ajg.2009.555","article-title":"Sequential therapy or triple therapy for Helicobacter pylori infection: Systematic review and meta-analysis of randomized controlled trials in adults and children","volume":"104","author":"Gatta","year":"2009","journal-title":"Am J Gastroenterol"},{"key":"R25-3-20240828","first-page":"357","article-title":"First- and second-line Helicobacter pylori eradication with modified sequential therapy and modified levofloxacin-amoxicillin-based triple therapy","volume":"27","author":"Zullo","year":"2014","journal-title":"Ann Gastroenterol"},{"key":"R26-3-20240828","first-page":"CD009034","article-title":"Sequential versus standard triple first-line therapy for Helicobacter pylori eradication","volume":"2016","author":"Nyssen","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"R27-3-20240828","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1097\/MCG.0b013e3181c8a1a3","article-title":"Sequential therapy for Helicobacter pylori eradication: A critical review","volume":"44","author":"Gisbert","year":"2010","journal-title":"J Clin Gastroenterol"},{"key":"R28-3-20240828","first-page":"77","article-title":"Helicobacter pylori treatment: Is sequential or quadruple therapy the answer?","volume":"8","author":"Vakil","year":"2008","journal-title":"Rev Gastroenterol Disord"},{"key":"R29-3-20240828","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1111\/j.1365-2036.2011.04770.x","article-title":"Review article: Non-bismuth quadruple (concomitant) therapy for eradication of Helicobater pylori","volume":"34","author":"Gisbert","year":"2011","journal-title":"Aliment Pharmacol Ther"},{"key":"R30-3-20240828","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1038\/ncpgasthep1138","article-title":"New concepts of resistance in the treatment of Helicobacter pylori infections","volume":"5","author":"Graham","year":"2008","journal-title":"Nat Clin Pract Gastroenterol Hepatol"},{"key":"R31-3-20240828","doi-asserted-by":"crossref","first-page":"23","DOI":"10.2147\/CEG.S25419","article-title":"Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori","volume":"5","author":"Gisbert","year":"2012","journal-title":"Clin Exp Gastroenterol"},{"key":"R32-3-20240828","doi-asserted-by":"crossref","first-page":"e1000251","DOI":"10.1371\/journal.pmed.1000251","article-title":"CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials","volume":"7","author":"Schulz","year":"2010","journal-title":"PLoS Med"},{"key":"R33-3-20240828","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1038\/ajg.2009.508","article-title":"Empiric quadruple vs. triple therapy for primary treatment of Helicobacter pylori infection: Systematic review and meta-analysis of efficacy and tolerability","volume":"105","author":"Luther","year":"2010","journal-title":"Am J Gastroenterol"},{"key":"R34-3-20240828","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1111\/j.1365-2036.2005.02522.x","article-title":"A 10-day levofloxacin-based triple therapy in patients who have failed two eradication courses","volume":"22","author":"Gatta","year":"2005","journal-title":"Aliment Pharmacol Ther"},{"key":"R35-3-20240828","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/j.1365-2036.2004.02210.x","article-title":"Rifabutin- and furazolidone-based Helicobacter pylori eradication therapies after failure of standard first- and second-line eradication attempts in dyspepsia patients","volume":"21","author":"Qasim","year":"2005","journal-title":"Aliment Pharmacol Ther"},{"key":"R36-3-20240828","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1111\/j.1523-5378.2012.00960.x","article-title":"The efficacy of second-line anti-Helicobacter pylori therapy using an extended 14-day levofloxacin\/amoxicillin\/proton-pump inhibitor treatment \u2013 A pilot study","volume":"17","author":"Chuah","year":"2012","journal-title":"Helicobacter"},{"key":"R37-3-20240828","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s40364-017-0103-x","article-title":"Update on the first-line treatment for Helicobacter pylori infection \u2013 A continuing challenge from an old enemy","volume":"5","author":"Huang","year":"2017","journal-title":"Biomark Res"},{"key":"R38-3-20240828","doi-asserted-by":"crossref","first-page":"e12857","DOI":"10.1111\/eci.12857","article-title":"Treatment of Helicobacter pylori infection: A clinical practice update","volume":"48","author":"Zagari","year":"2018","journal-title":"Eur J Clin Invest"},{"key":"R39-3-20240828","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1016\/0006-291X(75)90200-4","article-title":"Beef liver L-Glutamate dehydrogenase mechanism: Presteady state study of the catalytic reduction of 2.oxoglutarate by NADPH","volume":"67","author":"Jallon","year":"1975","journal-title":"Biochem Biophys Res Commun"},{"key":"R40-3-20240828","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.3201\/eid1006.030744","article-title":"Antimicrobial resistance incidence and risk factors among Helicobacter pylori-infected persons, United States","volume":"10","author":"Duck","year":"2004","journal-title":"Emerg Infect Dis"},{"key":"R41-3-20240828","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1111\/j.1365-2036.2006.03144.x","article-title":"High prevalence and level of resistance to metronidazole, but lack of resistance to other antimicrobials in Helicobacter pylori, isolated from a multiracial population in Kuwait","volume":"24","author":"John Albert","year":"2006","journal-title":"Aliment Pharmacol Ther"},{"key":"R42-3-20240828","doi-asserted-by":"crossref","first-page":"3120","DOI":"10.1007\/s10620-010-1139-z","article-title":"Efficacy of standard triple therapy in the treatment of Helicobacter pylori infection: Experience from Kuwait","volume":"55","author":"Alazmi","year":"2010","journal-title":"Dig Dis Sci"},{"key":"R43-3-20240828","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.ajg.2015.09.007","article-title":"Quadruple therapy versus standard triple therapy for eradication of Helicobacter pylori in Kuwait","volume":"16","author":"Alboraie","year":"2015","journal-title":"Arab J Gastroenterol"},{"key":"R44-3-20240828","doi-asserted-by":"crossref","first-page":"f4587","DOI":"10.1136\/bmj.f4587","article-title":"Global eradication rates for Helicobacter pylori infection: Systematic review and meta-analysis of sequential therapy","volume":"347","author":"Gatta","year":"2013","journal-title":"BMJ"},{"key":"R45-3-20240828","first-page":"409","article-title":"Worldwide H. pylori antibiotic resistance: A systematic review","volume":"19","author":"De Francesco","year":"2010","journal-title":"J Gastrointestin Liver Dis"},{"key":"R46-3-20240828","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1046\/j.1365-2036.1999.00493.x","article-title":"The optimal antibiotic combination in a 5-day Helicobacter pylori eradication regimen","volume":"13","author":"Neville","year":"1999","journal-title":"Aliment Pharmacol Ther"},{"key":"R47-3-20240828","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1001\/archinte.162.2.153","article-title":"Clinical outcome and influencing factors of a new short-term quadruple therapy for Helicobacter pylori eradication: A randomized controlled trial (MACLOR study)","volume":"162","author":"Treiber","year":"2002","journal-title":"Arch Intern Med"},{"key":"R48-3-20240828","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1046\/j.1365-2036.2001.01006.x","article-title":"Predictors of failure of Helicobacter pylori eradication with the standard 'Maastricht triple therapy'","volume":"15","author":"Perri","year":"2001","journal-title":"Aliment Pharmacol Ther"}],"container-title":["Journal of Global Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jgid.jgid_13_22","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:12:05Z","timestamp":1787757125000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jgid.jgid_13_22"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7]]},"references-count":48,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.4103\/jgid.jgid_13_22","relation":{},"ISSN":["0974-777X"],"issn-type":[{"value":"0974-777X","type":"print"}],"subject":[],"published":{"date-parts":[[2022,7]]}}}