DUAL VERSUS TRIPLE THERAPY - COMPARISON OF 5 ANTIBIOTIC REGIMENS FOR ERADICATION OF HELICOBACTER-PYLORI IN A PROSPECTIVE, RANDOMIZED STUDY

We compared the efficacy of three dual and two triple therapies for er adication of Helicobacter pylori (HP), and evaluated the influence of smoking and omeprazole pretreatment on HP eradication. 220 patients wi th proven HP infection (histology and C-13-urea breath test [UBT]) wer e randomly allocated to one of the following regimes: BMT (bismuth sub salicylate 600 mg t. i. d. for 28 days, metronidazole 400 mg t, i. d, and tetracycline 500 mg q, i. d. for ten days). OA (omeprazole 40 mg o . d. and amoxicillin 750 mel q, i. d. for 14 days): OC (omeprazole 40 mg o. d. and clarithromycin 500 mg b, i. d, for 14 days), OT (omeprazo le 40 mg o. d, and tetracycline 500 mg q. i. d. for 14 days), OMC (ome prazole 40 mg o. d., metronidazole 400 mg t. i. d. and clarithromycin 250 mg b. i. d. for seven days). Eradication was defined as negative U BT six weeks after completion of the therapy. In an >>all-patients-tre ated< (>$$) over bar>per-protocol<<) analysis, the eradication rates w ere: BMT, 91% (93%); OA, 84% (90%); OC; 74% (74%); OT, 24% (24%); and OMC: 90% (93%). Smoking impaired the success of OA and OT (p < 0.05), but the efficacy of the triple regimens was not affected. Omeprazole p retreatment did not influence eradication rates. Thus. highest eradica tion rates were achieved with the two triple therapies tested. However . OA, given at a daily antibiotic dose of 3 g amoxicillin for 14 d, wa s also highly effective. After failure of triple therapy OA was succes sful in seven of ten patients (70%). The efficacy of OC was lower than that of the triple therapies (p < 0.05). In conclusion: metronidazole - and clarithromycin-based triple therapies are highly effective first line therapies. OA, given at a dose of 3 g per day over 14 days, shou ld be considered as a possible se cond line therapy e. g. in retherapy after failed triple therapy.