Omeprazole plus Amoxicillin for Cure of Helicobacter pylori Infection Factors Influencing the Treatment Success

Aim: Effective anti‐Helicobacter pylori therapies with few side‐effects are needed. We studied the effectiveness of a low‐dose combination of metronidazole, amoxycillin and omeprazole for treatment of ulcer patients in Seoul, Korea. Methods: Patients with gastric or duodenal ulcer received metronidazole (125 mg b.d.), amoxycillin (500 mg b.d.) and omeprazole (20 mg at bedtime) for 2 weeks. Endoscopic examinations were performed before treatment and at least 6 weeks after completion of antimicrobial therapy. H. pylori status was confirmed by histological examination of two gastric biopsies using the Genta stain. Results: Seventy‐nine patients (64 men, 15 women, mean age 46 years) with peptic ulcer were enrolled. H. pylori infection was cured in 56 (71%, 95% CI: 60–81%). The cure rate in non‐smokers was significantly higher than in smokers (88% vs. 65%, P=0.035). Twelve pre‐treatment isolates were available and metronidazole resistance was noted in all; H. pylori infection was cured in 10. Thirty‐six patients cured of H. pylori have been followed for 1 year (mean of 361 days) and 2 cases became reinfected (5.5%, 95% CI: 1–18%). Conclusions: The low‐dose combination of metronidazole, amoxycillin and omeprazole was effective even in the face of metronidazole resistance. Recurrence of H. pylori infection is infrequent even in countries with a high prevalence of H. pylori infection.

Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Successful low‐dose amoxycillin, metronidazole and omeprazole combination therapy in a population with a high frequency of metronidazole‐resistant Helicobacter pylori

Breuer

Kim

Gürer

et al. 1997

“…Incidence of adverse events caution, it has been coincidentally demonstrated in previous work. 6 It has also been shown that lower intragastric acidity is a predictor of successful eradication 7 and this mechanism has been previously proposed to explain the effect of age on eradication success. Although this study has shown that 5-day LCM gives a higher overall eradication rate, it appears to be less effective than a 7-day LCM regimen, especially against metronidazole-resistant strains.…”

Section: Discussionmentioning

confidence: 99%

The optimal antibiotic combination in a 5‐day Helicobacter pylori eradication regimen

Neville

Everett

Langworthy³

et al. 1999

Background : Current guidelines for Helicobacter pylori eradication recommend 7 days of a proton‐pump inhibitor, clarithromycin (C), and either metronidazole (M) or amoxycillin (A). A shorter course would be cheaper and could be as effective. Aim : This study was designed to investigate the efficacy of three 5‐day regimens based on lansoprazole (L). Methods : 168 dyspepsia patients with H. pylori infection were randomized to receive a 5‐day course of either LCM, LAC or CALM, and a 13C‐urea breath test was performed after 4 weeks to assess eradication. Results : 160 patients completed the study. Intention‐to‐treat eradication rates were as follows: LCM 81%, LAC 59%, CALM 88%. LCM and CALM gave significantly better eradication rates than LAC. There was no significant difference in adverse events across the three groups. Logistical regression analysis showed that the specific regimen used and the age of the patient were the only factors influencing eradication outcome. Conclusions : Five days of CALM yields acceptable eradication rates, and is cheaper than conventional 7‐day proton pump inhibitor‐triple therapy. It appears to offer good results in metronidazole‐resistant strains of H. pylori. A randomized trial comparing 5‐day CALM with conventional 7‐day therapy is needed before this regimen can be recommended for routine use.

“…4 Similarly, in an analysis of various studies advanced age was, among others, a signi®cant independent factor in predicting treatment success. 5 As this retrospective analysis was based on different treatment schedules and patient characteristics, we decided to perform a single-blind comparative study where H. pylori-positive patients were also prospectively matched for age. In addition, as in previous studies, 3±5 compliance was regarded as a major determinant, but only assessed by unreliable pill count or interview, and plasma levels of all applied drugs were monitored.…”

Section: Discussionmentioning

confidence: 99%

Age‐dependent eradication of Helicobacter pylori with dual therapy

Treiber

Ammon

Klotz

1997

A causative role is now accepted for Helicobacter pylori for the development of erosive gastritis, duodenal and gastric ulcer. Eradication of the infection results in cure of erosive gastritis and a stable remission of peptic ulcer. During the last few years different treatment regimens have been tried, of which omeprazole and amoxycillin have been the most frequently used because this dual therapy is simple (b.d. dosing for 2 weeks) and welltolerated. However, the eradication rates vary widely (10±80%) and the decisive factors in¯uencing the ef®cacy remain unclear. 1, 2Based on experience with classical triple therapy (bismuth salt + two antibiotics), age might be considered as an important factor. However, although one trial reported an association between H. pylori eradication rate and advanced age, 3 another study could not . Intragastric pH and plasma levels of the administered drugs were monitored over a dosing interval of 12 h. Results: The overall eradication rates were 45% (intention-to-treat, ITT, 27/60) or 47% (per protocol 27/58); they did not differ (ITT) between omeprazole (50%), lansoprazole (40%) and ranitidine (45%).