Optimal PPI-based triple therapy for the cure of Helicobacter pylori infection: a single center comparison of four 14-day schedules.
BACKGROUND
Helicobacter pylori eradication is accomplished using a wide array of drugs combined in a multitude of dosage schedules. The aim of the present study was to define the best 14-day eradication schedule using a PPI plus either two antibiotics or one antibiotic and bismuth.


METHODS
For this study, 367 subjects (198 males, 169 females, age 22-87 years) with document H. pylori infection of the stomach were recruited from out-patients of the Gastroenterology Department of the Venezia Hospital. In all patients, H. pylori infection was identified by histology and the CLO-test. Patients were treated as follows: 1) PPI (P) plus clarithromycin (C) 250 mg plus amoxicillin (A) 1000 mg bid (P + C + A); 2) P plus C plus bismuth subcitrate (B) 120 mg qid (P + C + B); 3) P plus C plus tinidazole (T) 500 mg bid (P + C + T); and 4) P plus A plus T bid (P + A + T). After two months, an upper gastrointestinal endoscopy was repeated for end point histological evaluation and the CLO- test. Positivity of one of the two methods was considered sufficient to define H. pylori as "not eradicated".


METHODS
Chi-squared test and Fisher exact test.


RESULTS
Thirty-three subjects dropped out (six due to adverse events). P + C + B was proven significantly less effective than P + C + A, P + C + T and P + A + T, eradication rates being, respectively, 75.0%, 90.5%, 87.6%, 92.0%, (p = .005, per protocol analysis).


CONCLUSIONS
All PPI-based triple therapies tested in this study were effective in curing H. pylori infection; however, P + C + B resulted in rates too low (< 85%) to be recommended. P + C + A and P + A + T resulted in the high cure rates and thus may be considered the treatment of choice.
Battaglia
G
G
Gastroenterology Department, Regional Hospital of Venezia, Padova, Italy.
Di Mario
F
F
Leandro
G
G
Benvenuti
M E
ME
Donisi
P M
PM
Vianello
F
F
Del Bò
N
N
Pasini
M
M
Pasquino
M
M
Vigneri
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000863:Antacids / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology; D001729:Bismuth / Q000494:pharmacology / Q000627:therapeutic use; D017291:Clarithromycin / Q000008:administration & dosage* / Q000494:pharmacology; D004334:Drug Administration Schedule; 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; D008875:Middle Aged; D054328:Proton Pump Inhibitors; D013997:Time Factors
D000863:Antacids; D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D017291:Clarithromycin; D001729:Bismuth