Comparison of Amoxicillin Administered Twice versus Four Times a Day in First-Line Helicobacter pylori Eradication Using Tegoprazan, Clarithromycin, and Bismuth: A Propensity Score Matching Analysis

This study aimed to investigate the effects of different amoxicillin (AMX) dosing schedules on bismuth quadruple therapy in <i>Helicobacter pylori</i> treatment-naïve patients. A total of 139 <i>H. pylori</i>-infected patients received a 2-week eradication regimen consisting of 50 mg tegoprazan, 500 mg clarithromycin, and 300 mg bismuth tripotassium dicitrate twice daily, 1000 mg AMX twice daily (BID group), or 500 mg AMX four times daily (QID group). We performed a urea breath test to evaluate <i>H. pylori</i> eradication eight weeks after treatment and compared the <i>H. pylori</i> eradication rate, patient compliance, and adverse drug events between the BID and QID groups. Based on propensity score matching, 114 and 100 patients were included in intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. The <i>H. pylori</i> eradication rate did not differ significantly according to the ITT (82.5% vs. 87.7%, <i>p</i> = 0.429) and PP (95.9% vs. 98.0%, <i>p</i> = 0.536) analyses between the BID and QID groups. No significant differences were found in treatment compliance or adverse drug event rates between the two groups. In conclusion, the eradication rate of first-line <i>H. pylori</i> therapy containing tegoprazan, clarithromycin, and bismuth was not affected by AMX dosing schedules administered twice and four times daily.