Short-term low-dose triple therapy with azithromycin, metronidazole and lansoprazole appears highly effective for the eradication of Helicobacter pylori.
BACKGROUND
Although the OCN (omeprazole, clarithromycin and nitroimidazoles) short-term low-dose regimens are regarded as 'the standard' in the treatment of Helicobacter pylori infection, azithromycin is a new-generation, acid-stable macrolide which may prove particularly useful for a new short-term low-dose triple therapy regimen.


OBJECTIVE
To further improve OCN eradication treatments by reducing both the number of pills and the total cost.


METHODS
A new short-term low-dose triple therapy (LAM) using lansoprazole 30 mg once a day for 1 week, azithromycin 500 mg once a day for 3 days, and metronidazole 250 mg twice a day for the same 3 days, was administrated to 60 patients presenting with H. pylori-positive gastritis with or without peptic ulcer, and compared with the classic 'Bazzoli regimen' (OCT: omeprazole, clarithromycin, tinidazole) in 60 matched patients. H. pylori infection before and after therapy was evaluated by a rapid urease test, conventional histology and toluidine-stained semi-thin sections. Three biopsies from the corpus and three from the antrum were taken during endoscopical examination before and 7-8 weeks after discontinuation of the treatment. Patient compliance, drug tolerance and drug costs were also taken into consideration.


RESULTS
H. pylori infection was eradicated 7-8 weeks after treatment in 56 of the 60 patients in the LAM group (93.3%), and in 52 of the 57 patients in the OCT group who completed the treatment (91.2%), with no statistical difference. When gastric or duodenal ulceration was present, ulcer healing was observed in all cases.


CONCLUSIONS
The new proposed short-term low-dose triple therapy (LAM) appears to be as effective as the OCT for the eradication of H. pylori infection. The new treatment, however, seems to have advantages in terms of drug tolerance, patient compliance and therapy cost.
Caselli
M
M
School of Gastroenterology, University of Ferrara, Italy.
Trevisani
L
L
Tursi
A
A
Sartori
S
S
Ruina
M
M
Luzzi
I
I
Gaudenzi
P
P
Alvisi
V
V
Gasbarrini
G
G
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D017963:Azithromycin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D001706:Biopsy; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D004381:Duodenal Ulcer / Q000382:microbiology; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D005756:Gastritis / Q000382:microbiology; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D016480:Helicobacter pylori; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D011446:Prospective Studies; D013276:Stomach Ulcer / Q000382:microbiology; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D064747:Lansoprazole; D008795:Metronidazole; D017963:Azithromycin; D009853:Omeprazole