title: Failure of a 1-day high-dose quadruple therapy for cure of Helicobacter pylori infection.
abstract: BACKGROUND
  The optimal duration of treatment for eradication of Helicobacter pylori has still to be defined. A 1-day high-dose quadruple therapy with a combination of amoxycillin (or tetracycline), metronidazole, a bismuth salt and a proton pump inhibitor has led to eradication rates of 57-77%. In view of the high frequency of metronidazole-resistant strains of H. pylori in Europe, we hypothesized that by using clarithromycin in place of metronidazole and by increasing the dose of proton pump inhibitor, the efficacy of a 1-day high-dose quadruple therapy could be improved.
  
  
  METHODS
  Patients were randomized to receive either amoxycillin 1000 mg b.d., clarithromycin 500 mg b.d. and lansoprazole 30 mg b.d. for 7 days, or amoxycillin 2000 mg q.d.s., clarithromycin 500 mg q.d.s., lansoprazole 30 mg t.d.s. and bismuth subcitrate 240 mg q.d.s. for 1 day.
  
  
  RESULTS
  It was originally intended to include 100 patients. The first planned interim analysis performed after follow-up was completed for 30 patients revealed H. pylori eradication rates of 80% (12/15) in the 7-day triple therapy group and 20% (3/15) in the 1-day quadruple therapy group, the difference being highly significant (P = 0.003). Because the efficacy of the 1-day treatment was so low, the study was stopped for ethical reasons. Eleven patients who failed with the 1-day treatment were re-treated with the 7-day triple therapy: the eradication rate was 91% (10/11).
  
  
  CONCLUSIONS
  One-day high-dose quadruple therapy with amoxycillin, clarithromycin, lansoprazole and bismuth subcitrate is dramatically less effective than the classic 7-day triple therapy with the same antibiotics.
authors: Department of Pharmacology and Anaesthesiology, University Hospitals of Geneva, Switzerland. joel-wermeille@diogenes.hcuge.ch
authors: J
authors: J
authors: Wermeille
authors: M
authors: M
authors: Cunningham
authors: B
authors: B
authors: Armenian
authors: G
authors: G
authors: Zelger
authors: P
authors: P
authors: Buri
authors: H
authors: H
authors: Merki
authors: A
authors: A
authors: Hadengue
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure