Modified seven-day, quadruple therapy as a first line Helicobacter pylori treatment

Background: Cure rates of 7-day triple therapy seem to be decreasing. Quadr uple therapies may be an alternative, although their complex administration makes patient acceptance difficult. Objective: To test the usefulness of a thrice a day, quadruple therapy to c ure Helicobacter pylori infection. Patients and methods: total of 122 consecutive patients with peptic ulcer a nd Helicobacter pylori infection were treated with omeprazole 20 mg b.d., t etracycline chlorhydrate 500 mg t.d.s., metronidazole 500 mg t.d.s., and bi smuth subcitrate 120 mg t.d.s. administered with meals for 7 days. Cure was tested by either endoscopy or breath test after 2 months, and by urea brea th test 6 months after therapy. Results: Seven patients were lost to follow-up. Of the remaining 115, 110 w ere cured at the first control, giving an intention-to-treat cure rate of 9 0.2% (95% CI: 83-95%) and a per protocol cure rate of 95.7% (95% CI: 90-98% ). One hundred three patients returned for a 6-month breath test; all but o ne were cured. Side-effects were minimal or minor in 47 patients (40.8%) an d moderate in four (3.4%). Compliance was good, 95% of patients taking more than 90% of the pills. Six (5%) patients stopped treatment after 1, 2, 4 ( two patients) and 6 (two patients) days. Conclusion: Thrice a day quadruple therapy shows excellent cure rates, far above 90%, is well-tolerated and compliance is easy. Head-to-head compariso n with triple therapies as first line Helicobacter pylori treatment seems w arranted.