ONE WEEK TRIPLE THERAPY FOR HELICOBACTER-PYLORI - A MULTICENTER COMPARATIVE-STUDY

Background-Eradication of Helicobacter pylori cures and prevents the r elapse of duodenal ulceration and also results in histological resolut ion of chronic active gastritis. Aim-To compare four treatment regimen s lasting seven days of a proton pump inhibitor and two antibiotics in the eradication of H. pylori. Patients-Men or women with H pylori pos itive duodenal ulceration or gastritis, or both. Methods-A single blin d, prospectively randomised, parallel group, comparative, multicentre study. After a positive CLO test, patients underwent histology, H pylo ri culture, and a C-13 urea breath test to confirm H pylori status. Tr eatment with one of four regimens: LAC, LAM, LCM, or OAM, where L is 3 0 mg of lansoprazole twice daily, A is 1 g of amoxycillin twice daily, M is 400 mg of metronidazole twice daily, C is 250 mg of clarithromyc in twice daily, and O is 20 mg of omeprazole twice daily, was assigned randomly. A follow up breath test was done at least 28 days after com pleting treatment. Results-H pylori eradication (intention to treat) w as 104/121 (86.0%) with LAC, 87/131 (66.4%) with LAM, 103/118 (87.3%) with LCM, and 94/126 (74.6%) with OAM. There was a significant differe nce (p < 0.001) in the proportion of patients in whom eradication was successful between LAC and LCM when compared with LAM, but no signific ant difference (p = 0.15) between LAM and OAM. Metronidazole resistanc e before treatment was identified as a significant prognostic factor w ith regard to eradication of H pylori. The regimens which contained me tronidazole were significantly less effective than those without metro nidazole in the presence of pretreatment resistant H pylori. There was no difference among the treatment groups with regard to the incidence and severity of adverse events reported. Conclusions-All four treatme nt regimens were safe and effective in eradicating H pylori in the pat ient population studied. LAC was the most efficacious treatment in pat ients with pretreatment metronidazole resistant H pylori, and was sign ificantly better than LAM and OAM in this group of patients.