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

Abstract

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.

Clarithromycin, amoxycillin and H2‐receptor antagonist therapy for Helicobacter pylori peptic ulcer disease in Korea

“…31 The absence of recurrence after successful therapy is in accordance with a previous study in Korea. 32 When high-level disinfection of endoscopes is carried out, reinfection rate in Korea is similar to that experienced in the United States or Europe.…”

Effect of ornidazole and clarithromycin resistance on eradication of Helicobacter pylori in peptic ulcer disease

“…In contrast, other studies have shown only a minor or no effect of metronidazole resistance in OAM 23 , . 24 …”

Standard‐dose lansoprazole is more effective than high‐dose ranitidine in achieving endoscopic healing and symptom relief in patients with moderately severe reflux oesophagitis

“…Reduced effectiveness in smokers has earlier been reported for proton pump inhibitors in the treatment of reflux oesophagitis 34 and of duodenal ulcers irrespective of antibiotic co‐treatment to eradicate Helicobacter pylori. 35 –37 The reason why proton pump inhibitors are less effective in smokers has not yet been elucidated and deserves further investigation.…”