title: The ideal therapy must be defined in each geographical area: experience with a quadruple therapy in Spain.
abstract: BACKGROUND
  Multiple therapeutic combinations have been tested to determine the optimal regimen(s) for Helicobacter pylori eradication, leading to very different results depending on the geographical area. Our goal was to evaluate the efficacy of a "quadruple" therapy with omeprazole, tetracycline, bismuth and metronidazole in our area.
  
  
  METHODS
  We investigate 106 consecutive patients with active peptic ulcer disease (duodenal, gastric or both) and Helicobacter pylori infection. One-week therapy with omeprazole 20 mg b.i.d., tetracycline hydrochloride 500 mg q.i.d., colloidal bismuth subcitrate 120 mg q.i.d., and metronidazole 250 mg t.i.d was prescribed. Between the days 30 and 40 after treatment ended follow-up endoscopy was performed. Eradication was defined as both negative urease test and histology. Between days 90 and 360 a 13C urea breath test was performed in 100 patients.
  
  
  RESULTS
  Of the 106 patients in the study, 91 had duodenal ulcer, 12 had gastric ulcer, and 3 had both. Side effects were observed in 25% of the cases. Eradication was achieved in 87.7% (93/106; CI 79.9-93.3). Healing was obtained in 95.2% (100/105; CI 89.2-98.4); 97.8% (CI 92.4-99.7) in those eradicated and 75% (CI 42.8-94.5) in non-eradicated (p < .01).
  
  
  CONCLUSIONS
  Quadruple therapy with omeprazole, tetracycline, bismuth subcitrate and metronidazole achieves healing rates up to 95-100%. The 87.7% eradication rate obtained suggests that the regimen we used is a reasonable therapeutic alternative in our area.
authors.affiliation: Hospital Miguel Servet, Digestive Diseases Service, Zaragoza, Spain. fgomollong@meditex.es
authors.forename: F
authors.initials: F
authors.lastname: Gomollón
authors.forename: J A
authors.initials: JA
authors.lastname: Ducóns
authors.forename: L
authors.initials: L
authors.lastname: Gimeno
authors.forename: J
authors.initials: J
authors.lastname: Fuentes
authors.forename: S
authors.initials: S
authors.lastname: García
authors.forename: J
authors.initials: J
authors.lastname: Vera
authors.forename: M
authors.initials: M
authors.lastname: Montoro
mesh_terms: D000328:Adult; D000863:Antacids / Q000494:pharmacology / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001729:Bismuth / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D009853:Omeprazole / Q000494:pharmacology / Q000627:therapeutic use*; D013030:Spain; D013752:Tetracycline / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000863:Antacids; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D008795:Metronidazole; D013752:Tetracycline; D009853:Omeprazole; D001729:Bismuth