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One week triple therapy for Helicobacter pylori: amulticentre comparative study |
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| Authors: | J Misiewicz A Harris K Bardhan S Levi C O'Morain B Cooper G Kerr M Dixon H Langworthy D Piper H Lansoprazole |
| Affiliation: | Department of Gastroenterology and Nutrition, Central Middlesex Hospital NHS Trust, Park Royal, London, UK. |
| Abstract: | Background—Eradication ofHelicobacter pylori cures and prevents the relapse ofduodenal ulceration and also results in histological resolution ofchronic active gastritis. Aim—To compare four treatment regimenslasting seven days of a proton pump inhibitor and two antibiotics inthe eradication of H pylori. Patients—Men or women with Hpylori positive duodenal ulceration or gastritis, or both. Methods—A single blind, prospectively randomised,parallel group, comparative, multicentre study. After a positive CLOtest, patients underwent histology, H pylori culture, anda 13C urea breath test to confirm H pyloristatus. Treatment with one of four regimens: LAC, LAM, LCM, or OAM,where L is 30 mg of lansoprazole twice daily, A is 1 g of amoxycillintwice daily, M is 400 mg of metronidazole twice daily, C is 250 mg ofclarithromycin twice daily, and O is 20 mg of omeprazole twice daily,was assigned randomly. A follow up breath test was done at least 28 days after completing treatment. Results—H pylori eradication(intention to treat) was 104/121 (86.0%) with LAC, 87/131 (66.4%)with LAM, 103/118 (87.3%) with LCM, and 94/126 (74.6%) with OAM.There was a significant difference (p < 0.001) in the proportion ofpatients in whom eradication was successful between LAC and LCM whencompared with LAM, but no significant difference (p = 0.15) between LAMand OAM. Metronidazole resistance before treatment was identified as asignificant prognostic factor with regard to eradication of Hpylori. The regimens which contained metronidazole weresignificantly less effective than those without metronidazole in thepresence of pretreatment resistant H pylori. There was nodifference among the treatment groups with regard to the incidence andseverity of adverse events reported. Conclusions—All four treatment regimenswere safe and effective in eradicating H pylori in thepatient population studied. LAC was the most efficacious treatment inpatients with pretreatment metronidazole resistant Hpylori, and was significantly better than LAM and OAM in thisgroup of patients. Keywords:eradication; Helicobacterpylori; lansoprazole; omeprazole; metronidazole resistance |
| Keywords: | eradication Helicobacterpylori lansoprazole omeprazole metronidazole resistance |