SAFETY AND EFFICACY OF RABEPRAZOLE IN COMBINATION WITH 4 ANTIBIOTIC REGIMENS FOR THE ERADICATION OF HELICOBACTER-PYLORI IN PATIENTS WITH CHRONIC GASTRITIS WITH OR WITHOUT PEPTIC-ULCERATION

Objectives: Rabeprazole is a new fast acting proton pump inhibitor tha t has recently been proven to be effective in the treatment of peptic ulceration and reflux esophagitis. The aim of this study was to evalua te rabeprazole in combination with antibiotics for the eradication of Helicobacter pylori (H. pylori) in patients with chronic active gastri tis with or without peptic ulcer disease. Methods: Seventy-five H. pyl ori-infected patients were randomized in a double-blind fashion to rec eive a 7-day treatment regimen consisting of: RAC, RAM, RCM, or RC (R = rabeprazole 20 mg b.d., A = amoxycillin 1 g b.d., C = clarithromycin 500 mg b.d., M = metronidazole 400 mg b.d.). Randomized patients were H. pylori-positive by gastric biopsy urease test, histology and C-13 urea breath test (C-13-UBT). H. pylori eradication was assessed by C-1 3-UBT, 4 and 8 wk after finishing treatment. Endoscopy with histology and culture for antibiotic sensitivity testing was performed pretreatm ent and if treatment failed. Results: On an intention-to-treat analysi s, treatment success was: RCM 100%, RAC 95%, RAM 90%, and RC 63%. The most common side effects were loose stools, headache, and taste distur bance, but there were no serious adverse events related to the study m edication. The two patients failing RAM treatment had metronidazole-re sistant strains before and after treatment. None of the pretreatment H . pylori isolates from six patients failing RC were clarithromycin res istant, but three of five successfully cultured posttreatment had deve loped clarithromycin resistance. Conclusion: Rabeprazole-based triple therapy with two antibiotics for 1 wk is safe and effective in eradica ting H. pylori. Dual therapy with clarithromycin is less successful, a nd the majority of treatment failures develop clarithromycin resistanc e. (Am J Gastroenterol 1998;93: 1909-1913. (C) 1998 by Am. Coll. of Ga stroenterology)