A RANDOMIZED PROSPECTIVE COMPARISON OF CLARITHROMYCIN VERSUS AMOXICILLIN IN COMBINATION WITH OMEPRAZOLE FOR ERADICATION OF HELICOBACTER-PYLORI

Aim: To compare H. pylori eradication rates using omeprazole in conjun ction with either amoxycillin or clarithromycin. Background: Omeprazol e with amoxycillin is the most widely used dual therapy regimen for er adication of H. pylori. A recent open study suggested a high eradicati on rate combining omeprazole with the newer macrolide, clarithromycin. Methods: A randomized prospective trial in 54 patients was conducted to compare 2 weeks of treatment with omeprazole 40 mg once daily and e ither amoxycillin 500 mg three times daily or clarithromycin 500 mg th ree times daily. H. pylori eradication was assessed using the C-13 ure a breath test. Results: Eradication was achieved in 18/26 (69.2%) of s ubjects treated with omeprazole and amoxycillin and 18/25 (72.0%) of t hose treated with omeprazole and clarithromycin (P = N.S.). Minor side effects, most commonly altered taste, were reported by 16% of patient s and were more frequent in those randomized to clarithromycin (P = 0. 01). Conclusions: These regimens are similarly effective. However, cla rithromycin is more expensive, associated with a greater frequency of side effects and, unlike amoxycillin, resistance by H. pylori has been reported. This suggests that clarithromycin may be a useful alternati ve when there is penicillin allergy or previous treatment failure, but it should not replace amoxycillin as first choice in omeprazole-based dual therapy.