Helicobacter pylori eradication: efficacy and side effect profile of a combination of omeprazole, amoxycillin and metronidazole compared with four alternative regimens

We evaluated eradication of Helicobacter pylori infection in263 patients by a new 14-day regimen of omeprazole 40 mg mane(a gastric secretory inhibitor) plus two antibiotics: amoxycillin500 mg three-times daily (tds) plus metronidazole 400 mg tds.The comparative groups included updated results of our previouswork with a 14-day course of either standard triple therapy(STT, colloidal bismuth subcitrate 120 mg four times daily (qds)plus tetracycline 500 mg qds and metronidazole 400 mg tds),omeprazole 40 mg once daily plus amoxycillin 500 mg tds (OA),or two modified triple therapy: either Borody's (BTT) of allthree components (colloidal bismuth subcitrate 120 mg, tetracycline500 mg, metronidazole 200 mg) qds instead of tds, or Logan's(ITT) seven-day therapeutic regimen of colloidal bismuth subcitrate120 mg qds, amoxycillin 500 mg qds and, for the last three days,metronidazole 400 mg five times daily. Omeprazole/amoxycillin/metronidazole (OAM) therapy was bettertolerated than STT (course completion 98.1% vs. 81.4%, p <0.001). H. pylori was eradicated by OAM therapy in 53/55 (96.4%)patients with metronidazole-sensitive organisms and in 54/72(75.0%) with metronidazole-resistant isolates (p < 0.01).The respective corresponding rates for STT and OA therapy were20/22 (90.9%) and 14/29 (48.3%), (metronidazole-sensitive organisms)and 7/21 (33.3%) and 15/31 (48.4%) (infections resistant tometronidazole). BTT and LTT were also better tolerated than STT. The eradicationrate for BTT was 23/26 (88.5%) but that for LTT, the best toleratedof the five treatment regimens, was only 19/28 (67.9%) whenpretreat-ment isolates were metronidazole-sensitive. OAM therapywas better tolerated than either STT or BTT. With metronidazole-sensitiveorganisms, all three regimens eradicated about 90% of the organisms,although in our hands LTT was significantly less effective (67.9%).In patients infected with metronidazole-resistant organisms,OAM therapy was significantly (p < 0.01) more effective thanSTT (95% Cl 19.2–64.2). These results support our current practice of prescribing OAMfor patients with duodenal ulcer infected with H. pylori, reservingBTT for patients allergic to penicillin.