A randomized comparison of four omeprazole-based triple therapy regimens for the eradication of Helicobacter pylori in patients with non-ulcer dyspepsia

Background: Helicobacter pylori eradication rates in France after therapy w ith omeprazole, amoxicillin and clarithromycin are among the lowest in Euro pe. This study evaluated alternative eradication regimens. Methods: Helicobacter pylori-positive patients (n=323) with non-ulcer dyspe psia were randomized to receive one of four 1-week regimens consisting of o meprazole, 20 mg b.d., plus either: amoxicillin, 1000 mg b.d., and clarithr omycin, 500 mg b.d. (OAC); bacampicillin, 1200 mg b.d., and clarithromycin, 500 mg b.d. (OBC); clarithromycin, 250 mg b.d., and metronidazole, 500 mg b.d. (OCM); or amoxicillin, 1000 mg b.d. and azithromycin, 500 mg on day 1 and 250 mg on days 2-5 (OAAz). Eradication was confirmed by urea breath tes t 4-6 weeks after treatment. Susceptibility testing was performed in the ca se of eradication failure. Results: The eradication rate with OAAz was 38% (95% CI, 25.6-49.4) on inte ntion-to-treat analysis, which was lower (P<0.05) than with the other regim ens [OCM, 61% (50.0-72.8); OBC, 65% (54.0-76.5); OAC, 72% (61.8-81.8)]. Of the strains isolated following treatment failure with OAC, OBC or OCM, 84% were clarithromycin resistant. Conclusions: OAC remains the reference treatment for H. pylori eradication in France, although bacampicillin offers a useful alternative to amoxicilli n, Susceptibility testing should be considered after unsuccessful eradicati on therapy.