The optimal antibiotic combination in a 5-day Helicobacter pylori eradication regimen

Background: Current guidelines for Helicobacter pylori eradication recommen d 7 days of a proton-pump inhibitor, clarithromycin (C), and either metroni dazole (M) or amoxycillin (A). A shorter course would be cheaper and could be as effective. Aim: This study was designed to investigate the efficacy of three 5-day reg imens based on lansoprazole (L). Methods: 168 dyspepsia patients with H. pylori infection were randomized to receive a 5-day course of either LCM, LAC or CALM, and a C-13-urea breath test was performed after 4 weeks to assess eradication. Results: 160 patients completed the study. Intention-to-treat eradication r ates were as follows: LCM 81%, LAC 59%, CALM 88%, LCM and CALM gave signifi cantly better eradication rates than LAC. There was no significant differen ce in adverse events across the three groups. Logistical regression analysi s showed that the specific regimen used and the age of the patient were the only factors influencing eradication outcome. Conclusions: Five days of CALM yields acceptable eradication rates, and is cheaper than conventional 7-day proton pump inhibitor-triple therapy. It ap pears to offer good results in metronidazole-resistant strains of H. pylori . A randomized trial comparing 5-day CALM with conventional 7-day therapy i s needed before this regimen can be recommended for routine use.