ONE-WEEK THERAPY FOR HELICOBACTER-PYLORI - A RANDOMIZED TRIAL OF 2 TREATMENT REGIMENS

In clinical practice, eradication of Helicobacter pylori infection may be difficult due to medication side effects and the need for 2 weeks of therapy. Because therapies of shorter duration may improve patient compliance and reduce treatment side effects, we compared the efficacy and tolerability of two anti-H. pylori treatments of 1 week's duratio n. Patients with H. pylori infection were randomized to treatment with either (a) short-course triple therapy, composed of bismuth subsalicy late (Pepto-Bismol, Procter & Gamble, Cincinnati, OH, U.S.A.) two tabl ets four times daily, amoxicillin 1 g (two 500-mg tablets) twice daily , and metronidazole 500 mg four times daily on days 5-7 or (b) omepraz ole 40 mg twice a day with amoxicillin 1 g twice a day for 1 week. At least 4 weeks posttreatment, efficacy was evaluated with either histol ogical evaluation of antral biopsies for H. pylori or C-14 urea breath testing. Patients who failed initial therapy were allowed to cross ov er to the alternative treatment regimen after a minimum ''wash-out'' p eriod of 5 weeks. Patients completed a diary during therapy to monitor both compliance and side effects. Thirty-four patients completed the study, 10 receiving both treatment regimens. Treatment with the short- course triple therapy eradicated H. pylori in 78.3% of treat ments com pared with 38% with the high-dose omeprazole /amoxicillin combination (p < 0.05). Patients were highly com pliant with both treatments, and mild side effects, such as transient loose stools or abdominal pain, w ere common in both groups. This is the first report from North America confirming the success of the short-course triple therapy for the era dication of H. pylori. The high-dose omeprazole/amoxicillin regimen's eradication rate was markedly inferior to that achieved by the short-c ourse triple therapy regimen and should not be used. Comparative studi es of the short-course triple therapy regimen with other 7-day anti-H. pylori treatment regimen therapies are indicated.