THE IDEAL THERAPY MUST BE DEFINED IN EACH GEOGRAPHICAL AREA - EXPERIENCE WITH A QUADRUPLE THERAPY IN SPAIN

Background. Multiple therapeutic combinations have been tested to dete rmine the optimal regiments) for Helicobacter pylori eradication, lead ing to very different results depending on the geographical area. Our goal was to evaluate the efficacy of a ''quadruple'' therapy with omep razole, tetracycline, bismuth and metronidazole in our area. Materials and Methods. We investigate 106 consecutive patients with active pept ic ulcer disease )duodenal, gastric or both) and Helicobacter pylori i nfection. One-week therapy with omeprazole 20 mg b.i.d., tetracycline hydrochloride 500 mg q.i.d., colloidal bismuth subcitrate 120 mg q.i.d ., and metronidazole 250 mg t.i.d was prescribed. Between the days 30 and 40 after treatment ended follow-up endoscopy was performed. Eradic ation was defined as both negative urease test and histology. Between days 90 and 360 a C-13 urea breath test was performed in 100 patients. Results. Of the 106 patients in the study, 91 had duodenal ulcer, 12 had gastric ulcer, and 3 had both. Side effects were observed in 25% o f the cases. Eradication was achieved in 87.7% (93/106; CI 79.9-93.3). Healing was obtained in 95.2% (100/105; CI 89.2-98.4); 97.8% (CI 92.4 -99.7) in those eradicated and 75% (CI 42.8-94.5) in non-eradicated (p < .01). Conclusions. Quadruple therapy with omeprazole, tetracycline, bismuth subcitrate and metronidazole achieves healing rates up to 95- 100%. The 87.7% eradication rate obtained suggests that the regimen we used is a reasonable therapeutic alternative in our area.