ONE WEEK PROTON PUMP INHIBITOR-BASED TRIPLE THERAPY ERADICATES RESIDUAL HELICOBACTER-PYLORI AFTER FAILED DUAL THERAPY

The purposes of this study were to assess the efficacy of a 1-week pro ton pump inhibitor (PPI)-based triple therapy after failure of dual th erapy in Helicobacter pylori eradication, and to compare the effective ness of clarithromycin and metronidazole in this regimen. Between Janu ary 1996 and March 1997, 67 patients with persistent H. pylori infecti on after a 2-week course of dual therapy (amoxicillin plus omeprazole) were enrolled. They were randomly assigned to receive amoxicillin (10 00 mg twice daily) and omeprazole (20 mg twice daily) plus either metr onidazole (500 mg twice daily) or clarithromycin (250 mg twice daily). Endoscopy was performed in each patient to assess the status of H. Py lori using the rapid urease test (CLO test) and the histologic finding s before dual therapy, after dual therapy, and after triple therapy. H . pyloriisolates were tested for antibiotic resistance when triple the rapy failed. The 1-week triple therapy was well tolerated in both grou ps with no adverse effects severe enough to cause withdrawal from the trial. Residual H. pylori was eradicated in 94% (33/35) of patients in the clarithromycin group and 84% (27/32) in the metronidazole group; the difference was not statistically significant. All seven patients i n whom triple therapy failed were infected with metronidazole-resistan t isolates and tno also had clarithromycin-resistant isolates. This 1- week triple therapy is safe and effective in eradicating residual N. p ylori after dual therapy failure. Failure of the rescue regimen is rel ated to antimicrobial agent resistance. Because of the high metronidaz ole resistance rate in Taiwan, clarithromycin appears to be more promi sing than metronidazole for the control of H. pylori.