One‐week low‐dose triple therapy for Helicobacter pylori is sufficient for relief from symptoms and healing of duodenal ulcers

Labenz, Joachim; Idström, Jan‐Peter; Tillenburg, B; Peitz, Ulrich; Adamek, R. J.; Börsch, G

doi:10.1046/j.1365-2036.1997.80252000.x

Cited by 50 publications

(39 citation statements)

References 20 publications

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“…These findings are basically in agreement with a recently published randomized double-blind study by Labenz et al [30] showing that continuation of antisecretory drug therapy beyond anti-H. pylori therapy may be unnecessary to achieve rapid symptom relief and reliable healing of uncomplicated duodenal ulcers. In conclusion, combined treatment with OMC for the cure of H. pylori infection in duodenal ulcer patients is significantly more effective than standard dual therapy with OA.…”

Section: Discussionsupporting

confidence: 82%

Comparison of Omeprazole, Metronidazole and Clarithromycin with Omeprazole/Amoxicillin Dual-Therapy for the Cure of Helicobacter pylori Infection

Miehlke

Meining²,

Lehn

et al. 1998

Digestion

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In this randomized, multicenter trial, we evaluated the effectiveness and side effect profile of a modified omeprazole-based triple therapy to cure Helicobacter pylori infection. The control group consisted of patients treated with standard dual therapy comprising omeprazole and amoxicillin. One hundred and fifty-seven H. pylori infected patients with duodenal ulcers were randomly assigned to receive either a combination of omeprazole 10 mg, clarithromycin 250 mg and metronidazole 400 mg (OCM) given three times daily for 10 days (n = 81), or a combination of omeprazole 20 mg and amoxicillin 1 g (OA) given twice daily for 14 days (n = 76). Prior to treatment and after 2 and 6 weeks, gastric biopsies from the antrum and corpus were obtained for histology and H. pylori culture. H. pylori infection was cured in 97.4% after OCM and in 65.8% after OA in the per-protocol analysis (p < 0.001) (intention-to-treat analysis: 93.4% and 63.2%, respectively). H. pylori was successfully cultured in 122 patients (77%). The overall rate of metronidazole resistance was 19.7% (24/122), no primary resistance to clarithromycin or amoxicillin was found. In the OCM group, all patients infected with metronidazole-sensitive H. pylori strains (n = 51) and those infected with strains of unknown susceptibility to metronidazole (n = 14) were cured (100%), while 77% (10/13) of those harboring metronidazole-resistant strains were cured of the infection (p = 0.36). Side effects leading to premature termination of treatment occurred in 2.5% of the patients in the OCM group and in 1.4% of the OA group. We conclude that combined treatment with omeprazole, clarithromycin and a higher dose of metronidazole is highly effective in curing H. pylori infection, and that this regimen remains very effective in the presence of metronidazole-resistant strains.

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Section: Discussionsupporting

confidence: 82%

Comparison of Omeprazole, Metronidazole and Clarithromycin with Omeprazole/Amoxicillin Dual-Therapy for the Cure of Helicobacter pylori Infection

Miehlke

Meining²,

Lehn

et al. 1998

Digestion

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“…1 In another study, with a design similar to ours, all 52 patients had an ulcer, which was healed by 28 days, where the H. pylori cure rate was 96%. 2 In our study, as for other studies, the percentage of patients with healed ulcer was no different whether H. pylori was eradicated or not. However, although not significant, there is a tendency to a lower healing rate in patients where eradication failed, as was suggested in another recent study.…”

Section: Discussionsupporting

confidence: 80%

“…However, several studies have suggested that treatment for eradication of H. pylori without prolongation of anti-secretory treatment is sufficient to heal most of the duodenal ulcer. [1][2][3][4][5][6][7][8][9] The present study tests the hypothesis that the 1-week triple therapy for eradication of H. pylori alone is a convenient therapy regimen for uncomplicated H. pylori-associated duodenal ulcer.…”

Section: Introductionmentioning

confidence: 99%

Duodenal ulcer healing with 1‐week eradication triple therapy followed, or not, by anti‐secretory treatment: a multicentre double‐blind placebo‐controlled trial

Colin

2002

Aliment Pharmacol Ther

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Background: In the management of Helicobacter pylori induced duodenal ulcer, it is still controversial whether anti‐secretory treatment needs to be continued following a 1‐week course of eradication therapy. Methods: 150 patients with H. pylori active duodenal ulcer (diameter ≥ 5 mm) were included. After a 1‐week eradication treatment combining omeprazole 20 mg b.d., amoxicillin 1000 mg b.d. and clarithromycin 500 mg b.d. (OAC), patients were randomized to omeprazole 20 mg or placebo for 3 additional weeks. The primary variable was ulcer healing assessed at 4 weeks. Eradication was verified 4 weeks after cessation of study drugs by 13C‐urea breath test. Intention‐to‐treat analysis (ITT) included 131 patients with positive histopathology at inclusion. Results: Healing rates were not statistically different, at 89% and 87%, respectively, in the OAC–omeprazole and OAC–placebo groups (95% CI: –8.7; 13.7). Numerically, healing rates in patients with successful eradication was higher [94/104 (90%)] than in patients with failed eradication [21/27 (78%)]. However, the difference was not statistically significant (P < 0.1). Conclusions: One‐week OAC eradication triple therapy achieves excellent healing rates in patients with uncomplicated duodenal ulcer disease. Although the confidence interval of the difference in healing suggests little or no benefit of continued omeprazole treatment after 1 week, larger studies are needed to address this issue definitively.

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“…5). Among these studies, noteworthy is that performed by Labenz et al [43], in which two therapeutic strategies were randomly assigned: one group of patients received omeprazole, clarithromycin, and metronidazole during 7 days plus a further 3 weeks of omeprazole; the second group received the eradication regimen plus a further 3 weeks of placebo. The ulcer healing rates at 4 weeks were similar (100%) in both groups.…”

Section: Is It Necessary To Prolong Ppi Administration For Duodenal Umentioning

confidence: 99%

“…However, several authors have also achieved very high ulcer healing rates with 'short' eradication therapies using PPI only during 1 week [43][44][45][46][47][48][49][50][51] (fig. 5).…”

Section: Is It Necessary To Prolong Ppi Administration For Duodenal Umentioning

confidence: 99%

Helicobacter pylori Therapy: First-Line Options and Rescue Regimen

Gisbert

Jm²

2001

Dig Dis

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In the present paper, several points regarding Helicobacter pylori treatment are reviewed, with the following conclusions: (1) all different proton pump inhibitors (PPIs) are equivalent when prescribed with antibiotics; (2) ranitidine bismuth citrate is equal to or, in some cases with antibiotic resistance, more effective than PPI; (3) previous treatment with PPI does not seem to affect the rate of eradication obtained with PPI plus two antibiotics; (4) just 1 week of PPI is enough to obtain duodenal ulcer healing, provided that H. pylori eradication is achieved; (5) the eradication rates seem to be higher in peptic ulcer than in nonulcer dyspepsia; (6) in areas where the prevalence of metronidazole resistance is high, triple therapy including a PPI, clarithromycin, and amoxicillin is the best option, and (7) quadruple therapy (PPI, bismuth, tetracycline, and metronidazole) is the recommended second-line therapy after PPI-clarithromycin-amoxicillin failure, although replacing the PPI and the bismuth compound by ranitidine bismuth citrate achieves also good results.

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One‐week low‐dose triple therapy for Helicobacter pylori is sufficient for relief from symptoms and healing of duodenal ulcers

Cited by 50 publications

References 20 publications

Comparison of Omeprazole, Metronidazole and Clarithromycin with Omeprazole/Amoxicillin Dual-Therapy for the Cure of <i>Helicobacter pylori</i> Infection

Comparison of Omeprazole, Metronidazole and Clarithromycin with Omeprazole/Amoxicillin Dual-Therapy for the Cure of <i>Helicobacter pylori</i> Infection

Duodenal ulcer healing with 1‐week eradication triple therapy followed, or not, by anti‐secretory treatment: a multicentre double‐blind placebo‐controlled trial

<i>Helicobacter pylori</i> Therapy: First-Line Options and Rescue Regimen

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