OPTIMAL PPI-BASED TRIPLE THERAPY FOR THE CURE OF HELICOBACTER-PYLORI INFECTION - A SINGLE-CENTER COMPARISON OF 4 14-DAY SCHEDULES

Background. Helicobacter pylori eradication is accomplished using a wi de array of drugs combined in a multitude of dosage schedules. The aim of the present study was to define the best 14-day eradication schedu le using a PPI plus either two antibiotics or one antibiotic and bismu th. Material and Methods. For this study, 367 subjects (198 males, 169 females, age 22-87 years) with document H. pylori infection of the st omach were recruited from outpatients of the Gastroenterology Departme nt of the Venezia Hospital. In all patients, H. pylori infection was i dentified by histology and the CLO-test. Patients were treated as foll ows: 1) PPI(P) plus clarithromycin (C) 250 mg plus amoxicillin (A) 100 0mg bid (P+C+A); 2) P plus C plus bismuth subcitrate (Bi 120 mg qid (P +C+B); 3) P plus C plus tinidazole (T) 500 mg bid (P+C+T); and 4) P pl us A plus T bid (P+A+T). After two months, an upper gastrointestinal e ndoscopy was repeated for end point histological evaluation and the CL O-test. Positivity of one of the two methods was considered sufficient to define H. pylori as ''not rradicated''. Statistics: Chi-squared te st and Fisher exact test. Results. Thirty-three subjects dropped out ( six due to adverse events). P+C+B was proven significantly less effect ive than P+C+A, P+C+T and P+A+T, eradication rates being, respectively , 75.0%, 90.5%, 87.6%, 92.0%, (p = .005, per protocol analysis). Concl usions. All PPI-based triple therapies tested in this study were effec tive in curing H. pylori infection; however, P+C+B resulted in rates t oo low (< 85%) to be recommended. P+C+A and P+A+T resulted in the high cure rates and thus may be considered the treatment of choice.