A Four-Day Low Dose Triple Therapy Regimen for the Treatment of Helicobacter pylori Infection

Abstract

The new proposed ultrashort triple therapy, including lansoprazole, low dose azithromycin for 3 days, and a single dose of tinidazole, appears to be a very effective anti-H. pylori regimen, a simpler, cheaper, well-tolerated, and equally effective alternative to 1-wk triple therapy.

Evaluation of a new ultrashort triple therapy for Helicobacter pylori disease

“…In fact, it is very well tolerated, and achieves a high cure rate in an unselected population, with a low number of pills. The eradication rate obtained in the present study seems to be better than that of our prior trial, 8 in which tinidazole was administered as a single dose (intention-to-treat: 81.4% vs. 73.3%, respectively). However, in both studies we have not tested the antibiotic sensitivities, and therefore we cannot exclude that our ultrashort regimens may also be less effective in nitroimidazole resistant strains, as has been observed by other authors investigating different therapeutic regimens.…”

“…In our study, we have used lansoprazole and azithromycin in association with nitroimidazoles, and antibiotic treatment was initiated on the second day of therapy, with the aim of taking advantage of a higher intragastric pH during the period of activity of the chemotherapeutic agent. 25 In our recent experience, 8 ultra-short triple therapy including lansoprazole and low dose azithromycin for 3 days, alongside a single dose of tinidazole was shown to be as effective as 1-week triple therapy. A single 2 g dose of tinidazole produces a peak plasma concentration of 40 lg/mL, falling to about 10 lg/mL at 24 h and 2.5 lg/mL at 48 h. 26 In the present study, we administered tinidazole for an additional 2 days, with the aim of maintaining higher drug concentrations for a longer time in presence of elevated levels of azithromycin, to achieve a prolongation of the synergistic effect between the two chemotherapeutic agents.…”

“…7 In our previous experience with ultra-short therapy, which included lansoprazole, azithromycin and a single dose of tinidazole, we obtained results which were comparable to those obtained with 1-week triple therapy using omeprazole, clarithromycin and tinidazole, both in terms of ef®cacy, or in terms of tolerability. 8 Assuming that administering nitroimidazoles for a longer period may further improve the eradication rate, we planned this open study to assess the ef®cacy and tolerability of a new 3-day lansoprazole therapy, which included tinidazole and was administered for 3 days.…”

Comparison of five-day Helicobacter pylori eradication regimens: rabeprazole-based and omeprazole-based regimens with and without omeprazole pretreatment

“…6,7 Shorter-duration regimens have been attempted, but 3-to 5-day, PPI-based triple therapies have lower eradication rates. [11][12][13] The role of PPIs in these regimens has been reported to depend not only on the antimicrobial activity of the PPI but also on the PPI-induced high gastric pH environment. [8][9][10] High gastric pH is considered to play an important part in successful eradication because neutral gastric pH has been demonstrated to increase both levels of antimicrobial agents in the stomach and the sensitivity of H pylori to amoxicillin.…”

“…As the eradication rates of 3-to 5-day PPI-based triple therapies are reported to be significantly lower than those of 1-to 2week therapies, a 1-week duration for PPI-based triple therapies has been recommended. 6,7 However, previous studies [11][12][13] using short-term PPI-based eradication therapies mainly have used omeprazole as the PPI. Omeprazole requires time to demonstrate its potent inhibitory action on gastric acid secretion and is reported to exhibit its maximal acid suppressive effect after several days of administration.…”