SUCCESSFUL LOW-DOSE AMOXICILLIN, METRONIDAZOLE AND OMEPRAZOLE COMBINATION THERAPY IN A POPULATION WITH A HIGH-FREQUENCY OF METRONIDAZOLE-RESISTANT HELICOBACTER-PYLORI

Aim: Effective anti-Helicobacter pylori therapies with few side-effect s are needed. We studied the effectiveness of a low-dose combination o f metronidazole, amoxycillin and omeprazole for treatment of ulcer pat ients in Seoul, Korea. Methods: Patients with gastric or duodenal ulce r received metronidazole (125 mg b.d.), amoxycillin (500 mg b.d.) and omeprazole (20 mg at bedtime) for 2 weeks. Endoscopic examinations wer e performed before treatment and at least 6 weeks after completion of antimicrobial therapy. H. pylori status was confirmed by histological examination of two gastric biopsies using the Genta stain. Results: Se venty-nine patients (64 men, 15 women, mean age 46 years) with peptic ulcer were enrolled. H. pylori infection was cured in 56 (71%, 95% CI: 60-81%). The cure rate in non-smokers was significantly higher than i n smokers (88% vs. 65%, P = 0.035). Twelve pre-treatment isolates were available and metronidazole resistance was noted in all; H. pylori in fection was cured in 10. Thirty-six patients cured of H. pylori have b een followed for 1 year (mean of 361 days) and 2 cases became reinfect ed (5.5%, 95% CI: 1-18%). Conclusions: The low-dose combination of met ronidazole, amoxycillin and omeprazole was effective even in the face of metronidazole resistance. Recurrence of H. pylori infection is infr equent even in countries with a high prevalence of H. pylori infection .