OMEPRAZOLE AS AN ADJUVANT TO ANTIMICROBIAL THERAPY FOR ERADICATION OFHELICOBACTER-PYLORI INFECTION

The first therapies to reliably eradicate Helicobacter pylori used com binations of bismuth, metronidazole, and tetracycline or amoxicillin. The increasing frequency of metronidazole resistance, however, has lim ited the effectiveness of the original combination therapies. As with the use of bismuth compounds, proton pump inhibitors can be used to ki ll H pylori but are themselves insufficient to eradicate the infection . Proton pump inhibitors markedly increase gastric pH. Because this ac tion may make antimicrobials more effective, we evaluated omeprazole a s an adjuvant to antimicrobial therapy. We tested omeprazole 20 mg TID for 7 days as an adjuvant to oral clarithromycin 500 mg TID or gentam icin 20 mg TID (each was given for the final 5 days of the 7-day treat ment course). Eradication was defined as the absence of evidence of H pylori 4 or more weeks after cessation of therapy. Eleven patients wit h active peptic ulcer disease were treated with omeprazole/clarithromy cin; the eradication rate was 64%. Six healthy H pylori-infected volun teers were treated with omeprazole/gentamicin; no eradication was achi eved. Omeprazole appears to be a useful adjuvant to some therapies but the results cannot be predicted. Combination therapy with omeprazole and clarithromycin warrants further study.