HELICOBACTER-PYLORI ERADICATION - EFFICACY AND SIDE-EFFECT PROFILE OF A COMBINATION OF OMEPRAZOLE, AMOXICILLIN AND METRONIDAZOLE COMPARED WITH 4 ALTERNATIVE REGIMENS

We evaluated eradication of Helicobacter pylori infection in 263 patients by a new 14-day regimen of omeprazole 40 mg mane (a gastric secretory inhibitor) plus two antibiotics: amoxycillin 500 mg three-times daily (tds) plus metronidazole 400 mg tds. The comparative groups included updated results of our previous work with a 14-day course of either standard triple therapy (STT, colloidal bismuth subcitrate 120 mg four times daily (qds) plus tetracycline 500 mg qds and metronidazole 400 mg tds), omeprazole 40 mg once daily plus amoxycillin 500 mg tds (OA), or two modified triple therapy: either Borody's (BTT) of all three components (colloidal bismuth subcitrate 120 mg, tetracycline 500 mg, metronidazole 200 mg) qds instead of tds, or Logan's (LTT) seven-day therapeutic regimen of colloidal bismuth subcitrate 120 mg qds, amoxycillin 500 mg qds and, for the last three days, metronidazole 400 mg five times daily. Omeprazole/amoxycillin/metronidazole (OAM) therapy was better tolerated than STT (course completion 98.1% vs. 81.4%, p < 0.001). H. pylori was eradicated by OAM therapy in 53/55 (96.4%) patients with metronidazole-sensitive organisms and (in 54/72 (75.0%) with metronidazole-resistant isolates p<0.01). The respective corresponding rates for STT and OA therapy were 20/22 (90.9%) and 14/29 (48.3%), (metronidazole-sensitive organisms) and 7/21 (33.3%) and 15/31 (48.4%) (infections resistant to metronidazole). BTT and LTT were also better tolerated than STT. The eradication rate for BTT was 23/26 (88.5%) but that for LTT, the best tolerated of the five treatment regimens, was only 19/28 (67.9%) when pretreatment isolates were metronidazole-sensitive. OAM therapy was better tolerated than either STT or BTT. With metronidazole-sensitive organisms, all three regimens eradicated about 90% of the organisms, although in our hands LTT was significantly less effective (67.9%). In patients infected with metronidazole-resistant organisms, OAM therapy was significantly (p<0.01) more effective than STT (95% Cl 19.2-64.2). These results support our current practice of prescribing OAM for patients with duodenal ulcer infected with H. pylori, reserving BTT for patients allergic to penicillin.