HELICOBACTER-PYLORI ERADICATION - EFFICACY AND SIDE-EFFECT PROFILE OFA COMBINATION OF OMEPRAZOLE, AMOXICILLIN AND METRONIDAZOLE COMPARED WITH 4 ALTERNATIVE REGIMENS

We evaluated eradication of Helicobacter pylori infection in 263 patie nts by a new 14-day regimen of omeprazole 40 mg mane (a gastric secret ory inhibitor) plus two antibiotics: amoxycillin 500 mg three-times da ily (tds) plus metronidazole 400 mg tds. The comparative groups includ ed updated results of our previous work with a 14-day course of either standard triple therapy (STT, colloidal bismuth subcitrate 120 mg fou r 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 all three c omponents (colloidal bismuth subcitrate 120 mg, tetracycline 500 mg, m etronidazole 200 mg) qds instead of tds, or Logan's (LTT) seven-day th erapeutic regimen of colloidal bismuth subcitrate 120 mg qds, amoxycil lin 500 mg qds and, for the last three days, metronidazole 400 mg five times daily. Omeprazole/amoxycillin/metronidazole (OAM) therapy was b etter tolerated 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 w ith metronidazole-sensitive organisms and (in 54/72 (75.0%) with metro nidazole-resistant isolates p<0.01). The respective corresponding rate s for STT and OA therapy were 20/22 (90.9%) and 14/29 (48.3%), (metron idazole-sensitive organisms) and 7/21 (33.3%) and 15/31 (48.4%) (infec tions resistant to metronidazole). BTT and LTT were also better tolera ted than STT. The eradication rate for BTT was 23/26 (88.5%) but that for LTT, the best tolerated of the five treatment regimens, was only 1 9/28 (67.9%) when pretreatment isolates were metronidazole-sensitive. OAM therapy was better tolerated than either STT or BTT. With metronid azole-sensitive organisms, all three regimens eradicated about 90% of the organisms, although in our hands LTT was significantly less effect ive (67.9%). In patients infected with metronidazole-resistant organis ms, OAM therapy was significantly (p<0.01) more effective than STT (95 % Cl 19.2-64.2). These results support our current practice of prescri bing OAM for patients with duodenal ulcer infected with H. pylori, res erving BTT for patients allergic to penicillin.