Efficacy of omeprazole plus two antimicrobials for the eradication of Helicobacter pylori in a Turkish population

Omeprazole combined with 2 antimicrobials has been suggested as a first-lin e option for Helicobacter pylori eradication in recent years. However, cont roversy exists regarding the efficacy of this protocol. This open-label, pr ospective clinical study investigated the efficacy of omeprazole-based trip le therapy for H pylori eradication in 518 patients with H pylori-positive functional dyspepsia with or without duodenal ulcer. Amoxicillin, macrolide s (clarithromycin or roxithromycin), and nitroimidazoles (metronidazole, or nidazole, or tinidazole) were the antibiotics used in the study. Nonulcer p atients were randomly assigned to 1 of 8 different treatment protocols and duodenal ulcer patients were randomly assigned to 1 of 4 different treatmen t protocols consisting of omeprazole (20 mg once daily for nonulcer patient s, 20 mg twice daily for ulcer patients for 14 days) with a combination of 2 of the above antimicrobials (for 10 days). H pylori infection was assesse d by histologic findings and a rapid urease test before therapy and 4 weeks after therapy ended. Four hundred fifty-nine patients completed their regi mens; 327 had functional dyspepsia (180 men, 147 women; median age, 39 year s; range, 18 to 70 years) and 132 had ulcers (81 men, 51 women; median age, 40 years; range, 18 to 70 years). Eradication of H pylori was achieved in 58.8% (270 of 459) of all patients, 58.1% (190 of 327) of nonulcer dyspepti c patients, and 60.6% (80 of 132) of duodenal ulcer patients. The eradicati on rate varied from 47.2% to 69.4% in different treatment protocols. There were no statistically significant differences in eradication rates in any t reatment group. AU drugs were generally well tolerated in all groups, and n o patient discontinued treatment because of side effects. Therapy with omep razole and 2 antimicrobials for H pylori had limited efficacy in a Turkish population. The reason for these results, which conflict with those of othe r studies, is not clear. Further investigations of regimens for the eradica tion of H pylori in our population are necessary.