Comparison of two 3-day Helicobacter pylori eradication regimens with a standard 1-week regimen

Background: The duration of Helicobacter pylori eradication regimens has de creased to 1 week with cure rates of over 90%, This can be attributed to th e use of triple drug regimens including potent inhibitors of gastric acid s ecretion and clarithromycin, There is no theoretical reason why shorter reg imens should not be possible. Aim: To compare two 3-day, low-dose, twice daily regimens with 1 week of om eprazole 20 mg b.d., clarithromycin 250 mg b.d., and metronidazole 400 mg b .d. (OCM). Methods: Outpatients referred for gastroscopy were screened by biopsy ureas e test. H. pylori-positive patients were randomized to receive either lanso prazole 30 mg b.d., tri-potassium dicitrato bismuthate one tablet b.d,, cla rithromycin 250 mg b.d., and amoxycillin 1 g b.d, for 3 days (LTdbCA), or r anitidine bismuth citrate 400 mg b.d., clarithromycin 250 mg b.d. and amoxy cillin 1 g b.d. for 3 days (RbcCA) or omeprazole 20 mg b.d., clarithromycin 250 mg b.d. and metronidazole 400 mg b.d. for 1 week (OCM). They were not pretreated with a gastric acid inhibitor. After 8 weeks, H. pylori status w as assessed by C-13 urea breath test. Results: 974 out of 1114 patients referred for gastroscopy were screened by biopsy urease test, 140 patients were not screened either because they wer e anticoagulated or for technical reasons, 334 patients were H. pylori-posi tive: 154 were excluded mostly because of allergy to penicillin and persona l reasons but 180 were randomized to treatment All regimens were well toler ated. For LTdbCA (n = 60), RbcCA (n = 59), and OCM (n = 61) the H. pylori cure ra tes (95% CI) were 23% (12-34), 14% (5-23) and 87% (79-95), respectively, us ing intention-to-treat analysis and 25% (14-36), 15% (6-24) and 88% (80-96) , respectively, if analysed per protocol, OCM was significantly superior to LTdbCA and RbcCA (P < 0.001) but there was no significant difference betwe en regimens LTdbCA and RbcCA. Conclusions: OCM is an extremely effective H. pylori eradication regimen. T he 3-day regimens tested both have poor cure rates, Pre-treatment with a pr oton pump inhibitor, higher doses or more frequent dosing may be necessary to increase the cure rate of short duration regimens. However, this could m ake them less acceptable than the H. pylori eradication regimens currently available.