No abstract

on Helicobacfer pylovi (H. pylori) recommended that, in suitable patients, the bacterium should be eradicated using a therapeutic regimen comprising a bismuth salt, tetracycline and metronidazole for two weeks.We have treated 40 patients infected with H. pylori with 'triple' therapy consisting of 120 mg tripotassium dicitrato bismuthate 4.d.s.. 500 mg tetracycline q.d.s. and 400 mg metronidazole t.d.s. for two weeks.The success rate, in terms of bacterial eradication, was 19/21 (90.5 %) in patients with metronidazole-sensitive organisms, compared with only 6/19 (31.6%) in patients whose H. pylori were resistant to metronidazole (P < 0.01). Side effects, particularly diarrhoea and vomiting/nausea, were common: 23/40 patients reported such symptoms during the 14-day course of therapy. Fifteen of these 23 patients completed the entire 14day course, although suffering from significant side effects, while the

Helicobacter pylori infection causes a number of gastrointestinal diseases and its current treatment is based on multidrug regimes including acid suppression and antimicrobials. The success of these regimes is determined by a number of factors including antibiotic resistance, which varies widely but is an increasing problem. Local data are important in establishing the most cost-effective eradication regime. Data have been collected prospectively on antibiotic resistance at Ipswich Hospital (Suffolk, UK) in all consecutive isolates of H. pylori from 1991 to 2001. The success of regimes consisting of a proton pump inhibitor, amoxycillin and metronidazole (PPI/A/M) has also been evaluated in patients found positive on serological testing in primary care using urea breath testing. Overall, metronidazole resistance was found in 31. 7 % of isolates and clarithromycin resistance in 5. 3 %. A significant increase in metronidazole resistance from 29. 1 to 37. 0 % (P ¼ 0. 022) and a decrease in clarithromycin resistance from 10. 3 to 3. 8 % (P ¼ 0. 014) was seen over the study period. Metronidazole resistance was significantly more common in women (P , 0. 001) and young patients (P , 0. 001). Eradication with PPI/A/M was successful in 89. 9 % of patients and did not change significantly over the study period. Eradication rates were lower in young patients (P , 0. 001). Whilst metronidazole resistance is increasing in Suffolk, this does not seem to have a significant effect on eradication rates. Metronidazole-based regimes are still effective first-line treatments in most patients. †Present address:

SUMMARYBackground 'Re-infection' with Helicobacter pylori after eradication has been estimated to occur in 0-14% of patients, although most so-called 're-infections' occur within the first year following 'eradication' and many may actually be due to recrudescence of a temporarily suppressed infection.

SUMMARY Background/aims: Current Helicobacter pylori eradication therapy for peptic ulcer disease usually involves a 2‐week course of either a bismuth preparation or omeprazole in combination with antibiotics. We have studied a shorter, 7‐day course of treatment to assess efficacy and tolerability. Methods: Four hundred and thirty‐six patients, in three non‐randomized groups, received omeprazole (40 mg mane), amoxycillin (500 mg t.d.s.) and metronidazole (400 mg t.d.s.): 308 patients received the triple combination for 14 days; 80 patients were treated for 7 days; and 48 patients received omeprazole and amoxycillin for 7 days but metronidazole for only 5 days. Results: Helicobacter pylori was eradicated in 89.5%, 91.1% and 87.5%, respectively (98.3%, 92.9% and 100% of metronidazole‐sensitive isolates and 75.6% and 88.2% of metronidazole‐resistant isolates in the first two groups). Side effects were significantly more frequent in patients who received 14 days (49%) compared with 7 days of treatment (33%); only 8/308 and 1/128 patients, respectively, failed to complete the course. Conclusions: On the basis of efficacy, tolerability and cost, we conclude that a 7‐day course of the omeprazole (40 mg mane), amoxycillin (500 mg t.d.s.) plus metronidazole (400 mg t.d.s.) combination is effective therapy for the eradication of H. pylori.