Short report: clarithromycin, an alternative to metronidazole in the triple therapy of Helicobacter pylori infection.
BACKGROUND
Triple therapy for Helicobacter pylori using metronidazole is less effective in patients with a metronidazole resistant strain. Moreover, metronidazole is responsible for many side-effects. This open study examined the efficacy and side-effects of a triple treatment regimen substituting clarithromycin for metronidazole.


METHODS
36 patients with a H. pylori infection, proven by culture, were treated with tripotassium dicitrato bismuthate 120 mg q.d.s., tetracycline 250 mg q.d.s. and clarithromycin 250 mg q.d.s. for 10 days. Eradication was defined as a negative culture and histological examination of antral biopsy specimens, taken at least 6 weeks after completion of the treatment.


RESULTS
Eradication was achieved in 26 patients (72%). The treatment was well tolerated with only 4 (11%) of the patients having significant side-effects.


CONCLUSIONS
Triple therapy with clarithromycin seems to be less effective than standard triple treatment when the prevalence of metronidazole resistance is low. It is suggested, however, that this combination could be a valuable alternative in areas with a high prevalence of metronidazole resistance.
Thijs
J C
JC
Department of Internal Medicine, Bethesda Hospital, Hoogeveen, The Netherlands.
Van Zwet
A A
AA
Moolenaar
W
W
Oom
J A
JA
De Korte
H
H
Runhaar
E A
EA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D013752:Tetracycline / Q000008:administration & dosage / Q000627:therapeutic use*
D000897:Anti-Ulcer Agents; D009942:Organometallic Compounds; D008795:Metronidazole; D013752:Tetracycline; D017291:Clarithromycin; C002791:bismuth tripotassium dicitrate