ANTIBIOTIC VERSUS MAINTENANCE THERAPY IN THE PREVENTION OF DUODENAL-ULCER RECURRENCE - RESULTS OF A MULTICENTRIC DOUBLE-BLIND RANDOMIZED TRIAL

Objectives. - Reduction of gastric acid secretion by maintenance thera py and eradication of Helicobacter pylori by antibiotic treatment have been shown to reduce duodenal ulcer relapse. This study compared the effect of two regimens, a 6-month maintenance on an H-2 receptor antag onist versus a one-week antibiotic therapy, on the rate of duodenal ul cer relapse in duodenal ulcer patients with gastric H. pylori infectio n. Methods. - We conducted a 30-week, double-blind, double-dummy, mult icentric clinical trial involving 119 patients (97 M, 22 F, mean age 3 9 +/- 14 years) randomly assigned to a daily dose of 40 mg famotidine for 6 weeks supplemented with, during the first week, either antibioti cs (500 mg amoxicillin q.i.d. and 500 mg tinidazole t.i.d. antibiotic group) or their placebo (maintenance group). Healed patients after 6 w eeks entered the 6-month maintenance phase: the maintenance group rece ived 20 mg famotidine at bedtime and the antibiotic group, a placebo. Endoscopy with antral biopsies was performed to allow a rapid urease t est, culture and histological examination upon entry, after 6 weeks, 3 months, and 6 months and, whenever symptoms recurred H. pylori status was regarded as positive if any one of these three rests was positive , and negative if all tests were negative. Results. - The 2 treatment groups were well balanced for all baseline characteristics. After 6 we eks, H. pylori was eradicated in 25 (45 %) patients in the antibiotic group, and in 1 (2 %) in the maintenance group (P < 0.01). In term of intention-to-treat, there was no significant difference in the healing rate after 6 weeks (93 and 83 % in the antibiotic and maintenance gro ups, respectively; P = 0.15) or in the relapse rate after 6 months (13 and 28 % in the antibiotic and maintenance groups, respectively; P = 0.17 Log-rank test). However, the overall failure rate (absence of hea ling, relapse) was lower (P = 0.04, Log-rank test) in the antibiotic g roup in which all relapses but one were observed in H. pylori positive patients. The rate of ulcer relapse (1/20) in patients of antibiotic group who remained free of H. pylori during the study, was significant ly (P < 0.01) lower compared with that of H. pylori positive patients in the maintenance group (11/44). During the first 6-week period, more side effects were observed in the antibiotic group than in the mainte nance group (4 vs 1 patient, respectively). Conclusions. - Our results indicate no significant difference between ulcer relapse rates after 6 months following a one-week antibiotic therapy or long-term maintena nce therapy. Short-term antibiotic therapy should be considered as a v aluable alternative to the long-term maintenance therapy.