Effectiveness of quadruple therapy using lansoprazole, instead of omeprazole, in curing Helicobacter pylori infection.
BACKGROUND
Omeprazole enhances the efficacy of bismuth-based triple therapy. It is unknown whether the same is true for other proton pump inhibitors. Lansoprazole has superior anti-Helicobacter activity in vitro and possibly also in vivo; therefore we investigated quadruple therapy with lansoprazole.


METHODS
In two studies performed in separate hospitals, a total of 67 Helicobacter pylori-positive patients were treated with 7-day quadruple therapy (lansoprazole, colloidal bismuth subcitrate, tetracycline, and metronidazole) after 3 days of lansoprazole pretreatment. Testing for cure was done by endoscopy in study 1 and by breath test in study 2.


RESULTS
Cure rates per protocol were 31 of 31 (100%) in study 1 and 30 of 32 (94%) in study 2. Intention-to-treat cure rates were 31 of 35 (89%) in study 1 and 30 of 32 (94%) in study 2. Cured overall were 32 of 34 with a metronidazole sensitive strain and 3 of 3 with a metronidazole-resistant strain. Data on side effects were collected from 51 patients. Twelve (21%) had no side effects, 27 (53%) had mild side effects, 10 (20%) had moderate side effects, but only 2 (4%) had severe side effects. Side effects, never were the reason that a patient stopped taking the medication.


CONCLUSIONS
The results with lansoprazole-quadruple therapy are comparable to the historic control group treated with omeprazole-quadruple therapy. The cure rare is very high, and although mild to moderate side effects occurred in many patients, everybody finished the treatment regime.
de Boer
W A
WA
Department of Internal Medicine and Clinical Microbiology, Sint Anna Hospital, Oss, The Netherlands.
van Etten
R J
RJ
Lai
J Y
JY
Schneeberger
P M
PM
van de Wouw
B A
BA
Driessen
W M
WM
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000328:Adult; D000368:Aged; D000863:Antacids / Q000008:administration & dosage / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000032:analysis; D001944:Breath Tests; D002247:Carbon Isotopes; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000201:enzymology / Q000302:isolation & purification; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D010437:Peptic Ulcer / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D013752:Tetracycline / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014508:Urea; D014510:Urease / Q000032:analysis
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000863:Antacids; D000897:Anti-Ulcer Agents; D001426:Bacterial Proteins; D002247:Carbon Isotopes; D004791:Enzyme Inhibitors; D009942:Organometallic Compounds; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D008795:Metronidazole; D014508:Urea; D014510:Urease; D013752:Tetracycline; C002791:bismuth tripotassium dicitrate; D009853:Omeprazole