Pantoprazole, amoxycillin and either azithromycin or clarithromycin for eradication of Helicobacter pylori in duodenal ulcer

Background: Studies have shown that 1-week triple therapy consisting of a p roton pump inhibitor, amoxycillin and clarithromycin may cure Helicobacter pylori infection in the majority of patients. Aim: To establish whether pantoprazole plus amoxycillin in association with either azithromycin or clarithromycin is useful in curing H. pylori infect ion in patients with a duodenal ulcer. Methods: One hundred and ten patients with active duodenal ulcers and H. py lori infection were treated with pantoprazole (days 1-7, 40 mg b.d.; days 8 -28 40 mg o.d.) plus amoxycillin 1 g b.d. for the first 7 days. Patients we re randomly assigned to receive either azithromycin 500 mg o.d. for the fir st 6 days (PAAz group; n=55) or clarithromycin 500 mg b.d. for the first 7 days of treatment (PAC group; n=55). H. pylori status was determined by ure ase test and histology before the treatment, and again 4 weeks after cessat ion of any medication. Results: One hundred and three patients completed the study. H. pylori infe ction was eradicated in 78% (39/50) of patients in the PAAz group (ITT anal ysis: 71%, 95% CI: 61-83%) vs. 81% (43/53) of patients in the PAC group (IT T analysis: 78%, 95% CI: 69-90%) (N.S.). All ulcers had healed. Conclusion: Our study shows that 1-week triple therapy with pantoprazole, a moxycillin and either azithromycin or clarithromycin is not satisfactory (< 80% ITT H. pylori eradication rate).