AMOXICILLIN METRONIDAZOLE/OMEPRAZOLE/CLARITHROMYCIN - A NEW, SHORT QUADRUPLE THERAPY FOR HELICOBACTER-PYLORI ERADICATION/

Background. Triple therapy regimens including two antibiotics plus aci d suppression have become the new standard therapy in Helicobacter pyl ori eradication because of success rates of about 90%. However, these regimens are still costly, duration is about one week or less, and sid e-effects are not negligible. We therefore evaluated a new quadruple t herapy, because theoretically a shorter duration of treatment may resu lt in reduced costs, fewer side-effects, and possibly in a lower poten tial for antibiotic resistances. Methods. Controlled, prospective pilo t study including H. pylori-positive patients with gastric or duodenal ulcers or erosive gastritis, treated after failure of dual therapy (p roton-pump-inhibitors or ranitidine plus amoxicillin) or for the first time. They were assigned to a one week triple standard therapy, consi sting of metronidazole 400 mg bid + omeprazole 20 mg bid + clarithromy cin 250 mg bid, or a newly created quadruple-regimen, which adds amoxi cillin (1 g bid) to the above triple regimen. Each of the four drugs w as given for 5 days. H. pylori status was checked by C-13 urea breath test before and after four weeks of therapy. Results. A total of 71 pa tients were treated by quadruple therapy, and 42 patients were treated by triple therapy. The eradication rate of H. pylori for patients und er quadruple treatment, without vs. with previous dual therapy, were 9 6% vs. 92% (42/44 vs. 22/24) by per protocol and 91% vs. 88% (42/46 vs . 22/25) by intention to treat analysis (comparisons not significant). No major side-effects were reported. Conclusions. Five-day quadruple therapy (with omeprazole, metronidazole, clarithromycin and amoxicilli n) represents an effective and safe new regimen for H. pylori eradicat ion.