EFFECTIVE TREATMENT AFTER FAILURE OF OMEPRAZOLE PLUS AMOXICILLIN TO ERADICATE HELICOBACTER-PYLORI INFECTION IN PEPTIC-ULCER DISEASE

Methods: Fifty patients with relapsing or complicated Helicobacter pyl ori positive duodenal (n = 41) or gastric ulcer disease (n = 9) and fa ilure of a combined treatment with omeprazole plus amoxycillin to erad icate H. pylori infection were re-treated with either oral triple ther apy (bismuth subsalicylate, metronidazole, tetracycline) plus ranitidi ne [group I: n = 221 or high-dose omeprazole (40 mg b.d. to t.d.s.) pl us amoxycillin (1 g t.d.s.) [group II: n = 28]. Results: Patients of g roup I and II had similar demographic and clinical characteristics. Th e overall proportion of eradication of H. pylori infection was 81.8% i n group I and 78.6% in group II (P = N.S.) as judged from negative bac terial findings by means of an urease test, specific culture and histo logy after modified Giemsa stain. Ulcer healing was observed in all pa tients after a maximum duration of 10 weeks. Ten patients on triple th erapy and only one patient on omeprazole plus amoxycillin (45.5% vs. 3 .6%; P < 0.001) complained of side effects without necessity of discon tinuation of the study medication in either group. Twenty patients (gr oup I: n = 10; group II: n = 10) with relapsing duodenal ulcer disease and successful cure were prospectively followed for one year without any evidence of ulcer relapse or H. pylori re-infection. Conclusion: O ral triple therapy plus ranitidine or high-dose omeprazole plus amoxyc illin remain highly effective in eradicating H. pylori infection in pa tients with peptic ulcer disease and treatment failure of omeprazole/a moxycillin, but the omeprazole enhanced antibiotic monotherapy seems t o be superior with regard to side effects. Thus, high-dose omeprazole/ amoxycillin is recommended as the treatment of first choice in these s elected patients. Triple therapy should be reserved for patients intol erant of amoxycillin.