TRIAL OF A MODIFIED TRIPLE THERAPY FOR HE LICOBACTER-PYLORI ERADICATION IN RECURRENT DUODENAL-ULCER

In a prospective trial we examined the efficacy and acceptability of a modified triple therapy in H. pylori (HP)-positive patients with recu rrent duodenal ulcer disease. Oral administration of amoxicillin for t wo weeks was substituted for one single injection of intramuscular dep ot penicillin (benzathine penicillin G). Additionally, patients were g iven ornidazole 500 mg tid for 14 days and 120 mg colloidal bismuth su bcitrate qid for 28 days. The patients were investigated for H. pylori colonization using a rapid urease test (CLO), histology (H&E-, Giemsa stain), culture (including determination of the minimal inhibitory con centrations for metronidazole, penicillin G and amoxicillin) and H. py lori serology (Cobas Core Anti-H. pylori EIA, F. Hoffmann-La Roche). C ontrol endoscopies using the same methods were performed 1 and 6 month s after eradication therapy. The eradication rate was 50% and the ulce r healing rate 90% 1 month after therapy. Ulcers recurred in 2/3 of pa tients with persistent infection vs 015 of HP-eradicated patients afte r 6 months. Both successfully HP-eradicated patients and patients with treatment failure exhibited comparable decreases in mean serum IgG an ti-HP concentration within 2 months. Discrimination between the two gr oups and hence identification of the eradication success by serology w as not possible within a time period of 2 months. After 6 months, seru m IgG anti-HP concentrations in non-HP-eradicated patients returned to pre-therapy values, in HP-eradicated patients the concentrations furt her decreased. The above-described modified triple therapy against HP cannot be recommended as a standard therapy, mainly because of the ins ufficient eradication effect. Occurrence of nitroimidazole resistance, and insufficient availability and/or activity of parenterally adminis tered penicillin, seem to be responsible for the rather poor result.