Medium- and high-dose omeprazole plus amoxicillin for eradication ofHelicobacter pylori in duodenal ulcer disease

Abstract

The purpose of the present study was to investigate the Helicobacter pylori eradication potency of combined amoxicillin-omeprazole treatment in patients with duodenal ulcer disease and to compare the efficacy of two omeprazole and amoxicillin doses concerning H. pylori eradication, ulcer healing, pain relief, and safety. Ninety patients with active H. pylori-positive (culture and/or histology) duodenal ulcer disease were randomly treated with either omeprazole 20 mg twice a day plus amoxicillin 1 g twice a day (group I, N = 30), omeprazole 40 mg twice a day plus amoxicillin 1 g twice a day (group II, N = 30), or omeprazole 40 mg twice a day plus amoxicillin 1 g three times a day (group III, N = 30) over two weeks, followed by ranitidine at bedtime for another four weeks. The overall proportion of H. pylori eradication was 83% and of ulcer healing 92% without statistically significant differences between the study groups. Complete pain relief occurred after a median of one day in all groups. Six patients complained of side effects during the therapy phase, which led to therapy discontinuation in one female patient. In conclusion, omeprazole plus amoxicillin is a highly effective and well-tolerated therapy regimen to eradicate H. pylori in duodenal ulcer disease. In addition, the results suggest that there is no clear dose-response relation between the dosages of omeprazole and amoxicillin used in this study on the one hand and the H. pylori eradication rates on the other.

One-Week Triple Regime Therapy Consisting of Pantoprazole, Amoxicillin and Clarithromycin for Cure of <i>Helicobacter pylori</i>-Associated Upper Gastrointestinal Diseases

“…The standard triple therapy consisting of bismuth plus metronidazole plus either amoxicillin or tetracycline was the most extensively studied regimen in the literature and offered the greatest likelihood of successful eradication particularly when tetracycline was used instead of amoxicillin [37, 38]. Studies using the dual regimen omeprazole plus amoxicillin as an antibiotic yielded unpredictable results with a wide range of reported eradication rates ranging from 48 to 88%, depending on the age of the patient, smoking habits, the dose, the duration of treatment, compliance and omeprazole pretreatment [39, 40, 41]. Changing amoxicillin for clarithromycin did not alter the outcome of management significantly [42, 43].…”

Dual proton pump inhibitor plus amoxicillin as an empiric anti-H. pylori therapy: studies from the United States

“…Amoxicillin and PPI dual therapy eventually fell into disfavor because it did not reliably produce high cure rates and it was replaced by triple therapy consisting of a PPI, amoxicillin, and clarithromycin or metronidazole [16]. However, a number of studies suggested that good success rates for H. pylori eradication could be obtained with dual therapy if the dose of the PPI were increased [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Improved results were also obtained by increasing the PPI dose with triple therapy, and it appears that this improvement was most likely related to the increase in treatment success based on improvement in the dual PPIamoxicillin component of the triple therapy [14,33,34].…”

Does Helicobacter pylori eradication depend on the period of amoxicillin treatment? A retrospective study

“…Classical triple therapy including metronidazole for 2 weeks is reported to have a high eradication rate (more than 90%). 1-3 Eradication with dual therapy of a proton pump inhibitor and antibiotics such as AMPC or CAM for 2 weeks has been used, [4][5][6]8 with a reported eradication rate of 80%-90%. Laine et al 7 reported that two-antibiotic combination therapy of AMPC (2 g/day) and CAM (1 g/day) with 40 mg omeprazole for 1-2 weeks eradicated H. pylori in 77% of patients (7 days' Statistical analysis was performed by linear regression analysis for the relationship between total amount of AMPC and eradication rate and, the 2 -test for comparisons of recurrence rate.…”

“…[1][2][3] In recent studies, the drugs were usually given for 1-2 weeks and the eradication rates were reported to be 40%-80% with the dual therapy and more than 90% with triple therapy including metronidazole or tinidazole. [4][5][6][7][8][9][10][11] However, the doses of antibiotics used in the United States and Europe were relatively high (AMPC 2-3 g/day) and the incidence of adverse effects was also relatively high (3%-17%). Although AMPC and clarythromycin (CAM) have been used as the antibiotics, strains resistant to CAM have been reported.…”