OMEPRAZOLE ENHANCES EFFICACY OF TRIPLE THERAPY IN ERADICATING HELICOBACTER-PYLORI

Triple therapy has been recommended as the most effective treatment fo r Helicobacter pylori eradication. Despite achieving a comparatively h igh eradication result, however, around 10% of patients still fail to be cured. Omeprazole can enhance efficacy of single and double antibio tic protocols and is particularly effective when combined with clarith romycin and a nitroimidazole. This study examined the effect of combin ing triple therapy with omeprazole. A prospective, randomised, unblind ed, single centre trial was carried out on consecutive patients with s ymptoms of dyspepsia and H pylori infection confirmed by rapid urease test, microbiological culture, and histological assessment. Patients w ere given a five times/day, 12 day course of colloidal bismuth subcitr ate chewable tablets (108 mg), tetracycline HCl (250 mg), and metronid azole (200 mg) with either 20 mg omeprazole twice daily (triple therap y+omeprazole) or 40 mg famotidine (triple therapy+famotidine) at night . Compliance and side effects were determined using a standard questio nnaire form. One hundred and twenty five of 165 triple therapy+omepraz ole patients and 124 of 171 triple therapy+famotidine patients returne d for rebiopsy four weeks after completion of treatment. Significantly more triple therapy+omeprazole patients achieved eradication 122 of 1 25 (97.6%) as assessed by negative urease test, culture, and histologi cal assessment, when compared with 110 of 124 (89%) triple therapy+fam otidine patients (p=0.006; chi(2)) There were 30 triple therapy+omepra zole (24%) and 26 triple therapy+famotidine (21%) patients with de nov o metronidazole resistant H pylori included in the study. Side effects were mild and infrequent and were comparable in both groups, although pain in duodenal ulcer, gastric ulcer, and oesophagitis patients seem ed to subside earlier in those taking omeprazole. Compliance (>95% of drugs taken) was achieved by 98% of patients of both groups. A 12 day regimen of triple therapy with omeprazole is more effective in achievi ng H pylori eradication than is triple therapy plus famotidine. Use of 20 mg omeprazole twice daily rather than 40 mg famotidine with a 12 d ay, low dose triple therapy enhances eradication to over 97% whether t he H pylori is metronidazole sensitive or resistant.