ONE-WEEK TRIPLE THERAPY WITH OMEPRAZOLE, AMOXICILLIN AND TINIDAZOLE FOR HELICOBACTER-PYLORI INFECTION - THE SIGNIFICANCE OF IMIDAZOLE RESISTANCE

Background: Triple therapy involving a proton pump inhibitor and two a ntibiotics has been suggested as an effective treatment for Helicobact er pylori infection. The impact of imidazole resistance on the efficac y of such regimens is largely unknown. Methods: One hundred patients w ith culture proven H. pylori infection were treated with omeprazole 40 mg b.d., amoxycillin 1000 mg b.d., and tinidazole 500 mg b.d. for one week. Pre-treatment imidazole susceptibility was measured by disk dif fusion. Resistance was confirmed by E-test. Eradication was assessed b y endoscopy 6-8 weeks after the end of treatment. In cases of doubt a C-13-urea breath test was performed. Side-effects were scored using a semiquantitative scale. Results: H. pylori was eradicated in 95% of th e patients with an imidazole-susceptible strain and in 69% of the pati ents with a resistant strain (P < 0.005). Significant side-effects wer e seen in 12%. Conclusion: This proton pump inhibitor triple therapy i s a simple, reasonably effective regimen with few significant side-eff ects. The efficacy is dependent on the susceptibility of the infecting H. pylori strain.