SIMPLIFIED 10-DAY BISMUTH TRIPLE THERAPY FOR CURE OF HELICOBACTER-PYLORI INFECTION - EXPERIENCE FROM CLINICAL-PRACTICE IN A POPULATION WITHA HIGH-FREQUENCY OF METRONIDAZOLE RESISTANCE

Objective: To evaluate the cure rate of Helicobacter pylori infection, including the impact of in vitro, metronidazole resistance (M-R), and the side effects of a simplified 10-day bismuth triple therapy in rou tine clinical practice, Methods: From September 1995 to March 1996, 24 8 consecutive H. pylori-positive patients received 10 days of bismuth subnitrate 150 mg, oxytetracycline 500 mg, and metronidazole 400 mg, a ll t.i.d. Before treatment, upper endoscopy, including biopsy specimen s for microbiological analysis and IgG serology were performed. M-R wa s found in 45% of females and 36% of males. At least 2 months after tr eatment, H. pylori status was assessed by the C-14 urea breath test (n = 131), endoscopy (n = 37), urea breath test and endoscopy (n = 63), or solely by IgG serology (n = 7), Ten patients withdrew, IgG serology was performed again after 1 yr. Results: H. pylori infection was cure d in 205 patients: 86% by all-patients-treated analysis and 83% by int ention-to-treat analysis. When patients were classified according to p retreatment metronidazole susceptibility, cure of infection was achiev ed in 76% of females harboring M-R strains versus 96% of those with se nsitive strains (p = 0,002) and in 81% versus 88% (p = 0.34) of males with M-R versus sensitive strains, respectively. Twelve patients (5%) had to stop treatment prematurely because of severe side effects, but eight of them were treated successfully, One case of H pylori infectio n (0.6%) was defected at 1-yr follow-up. Conclusions: Ten-day bismuth triple therapy t.i.d. was effective in curing H. pylori infection in t he context of routine clinical practice. The efficacy was reduced in f emales harboring M-R strains. (C) 1998 by Am, Coll, of Gastroenterolog y).