Efficacy of different Helicobacter pylori eradication regimens in patientsaffected by insulin-dependent diabetes mellitus

Background: Patients with insulin-dependent diabetes mellitus (IDDM) are of ten affected by chronic infections. antibiotic absorption, however, may be influenced by the disease. H. pylori eradication appears to be reduced in I DDM patients. The aim of the study was to evaluate the efficacy of the most common H. pylori eradication regimens in a population of IDDM-infected pat ients. Methods: One hundred and seventy-two IDDM patients were evaluated. H . pylori infection was assessed through the C-13-urea breath test, Infected patients were randomly assigned to three different standard 7-day eradicat ion regimens: 1) amoxicillin, clarithromycin, pantoprazole; 2) tinidazole, clarithromycin, ranitidine bismuth citrate; or 3) tinidazole. clarithromyci n, pantoprazole. Patients in whom eradication was not successful in the fir st cycle were subsequently submitted to a 7-day therapy with tinidazole, te tracycline, bismuth, and pantoprazole. Results: Thirty-seven per cent of ID DM patients were infected. None of the triple therapies used provided an er adication higher than 62%. Conversely, the quadruple regimen was successful in 88% of the patients. Ten per cent of the subjects undergoing the triple therapies showed minor side effects, without significant differences among groups, whereas side effects occurred in 25% of the patients treated with the quadruple therapy (P < 0.05). Conclusions: IDDM patients show a low H. pylori eradication rate with a standard triple therapy regardless of the re gimen utilized, the dosage and/or the duration of the therapy used appearin g not to be sufficient to eradicate the infection efficiently. The use of a quadruple regimen leads to the cure of a large percentage of the infected patients in whom the eradication was unsuccessful in the first therapy, alt hough it is accompanied by a greater incidence of minor side effects.