4-day triple therapy with rabeprazole, amoxicillin and clarithromycin in the eradication of Helicobacter pylori in patients with peptic ulcer disease- A pilot study

Background: it is well established that a 7-day triple therapy achieves era dication rates of Helicobacter pylori between 90% and 95%. Due to a lack of highly effective short-term eradication studies the aim of the present pil ot study was to investigate the effect of a 4-day triple therapy with the n ew proton pump inhibitor rabeprazole (20 mg b. i. d.) in combination with c larithromycin (500 mg b. i. d.) and amoxicillin (1 g b. i. d.) without acid -suppressive pre-treatment in patients with H. pylori-related peptic ulcer disease. Methods: 20 patients (11 men, 9 women) with endoscopically diagnosed peptic ulcers (gastric ulcer: n = 5; duodenal ulcer: n = 9; combined gastric and duodenal ulcer: n = 2, gastric or duodenal ulcer scars: n = 4) and H. pylor i infection were consecutively recruited. The Helicobacter pylori status wa s assessed by means of histology, CLO (urea-) test and C-13-urea breath tes t (C-13-UBT) at entry. Treatment success was determined by C-13-UBT 35-42 d ays after end of treatment. Results: In 18 out of the 20 patients (90%) [77-100%, 95%-Cl] a negative te st result was found in C-13-UBT 35-42 days after treatment. The 2 patients who remained H. pylori-positive had a duodenal ulcer. Conclusion: A 4-day triple therapy of rabeprazole in combination with clari thromycin and amoxicillin seems to be highly effective in eradicating tl. p ylori and well tolerated in patients with gastric and duodenal ulcer diseas e. The achieved eradication rate of 90% is comparable with the established 7-day triple therapy regimens. On the basis of these results and considerin g costs, side effects and compliance a large number of patients should be e nrolled in a confirmatory 4-day eradication trial.