Five-day proton pump inhibitor-based quadruple therapy regimen is more effective than 7-day triple therapy regimen for Helicobacter pylori infection

Background: There have been no reports that describe whether 5-day quadrupl e therapy (rabeprazole + amoxicillin + clarithromycin + metronidazole; RACM ) could substitute for standard 7-day triple therapy as a first-line therap y for Helicobacter pylori. Patients and methods: This study was designed as a randomized prospective s ingle centre study. A total of 160 H. pylori-positive patients who had not received therapy were given either a 5-day RACM regimen (n = 80, rabeprazol e 20 mg b.d., amoxicillin 750 mg b.d., clarithromycin 200 mg b.d. and metro nidazole 250 mg b.d.) or a 7-day RAC regimen (n = 80, rabeprazole 20 mg b.d ., amoxicillin 750 mg b.d. and clarithromycin 200 mg b.d.). Cure of the inf ection was assessed by a C-13 urea breath test 1 month after the completion of therapy. Results: The eradication rates of the 5-day RACM regimen and the 7-day RAC regimen were 93% (95% CI: 84-97%) and 81% (95% CI: 71-89%) by intention-to- treat analysis, 94% (95% CI: 86-98%) and 83% (95% CI: 73-91%) by all-patien ts-treated analysis analysis and 95% (95% CI: 87-98%; P < 0.05) and 82% (95 % CI: 72-90%) by per protocol analysis, respectively. No serious adverse ef fect was observed, and 99% of the patients reported complete compliance. Conclusions: The cure rate of the 5-day RACM regimen was more effective tha n the 7-day RAC regimen, suggesting that this regimen could be preferable a s a first-line therapy for H. pylori infection.