Triple therapy for Helicobacter pylori eradication: a comparison of pantoprazole once versus twice daily.
BACKGROUND
Proton pump inhibitor-based triple therapy is recommended as treatment for Helicobacter pylori eradication. The proton pump inhibitor may be given once or twice daily. However, little information is available on how these two treatment strategies compare.


METHODS
H. pylori-positive patients (two positive test results) with endoscopy-proven healed duodenal ulcer or non-ulcer dyspesia were randomly allocated to 1 week of double-blind treatment with pantoprazole 40 mg once or twice daily, plus clarithromycin 250 mg and metronidazole 400 mg twice daily. Eradication was defined as a negative 13C-urea breath test (13C-UBT) and histology, 4-5 weeks post-treatment. The follow-up phase comprised 12 months off therapy, with 13C-UBT at 6 and 12 months.


RESULTS
Two hundred and four patients received treatment: pantoprazole once daily (x1), n=104; twice daily (x2), n=100. Eradication rates were 84% in both the pantoprazole x1 and pantoprazole x2 groups by modified intention-to-treat analysis and 89% and 87%, respectively, by per protocol analysis. Metronidazole resistance was found in 44% of pre-treatment cultures of H. pylori. Eradication rates were similar in susceptible (72%) and resistant (75%) strains. During follow-up, recrudescence of infection occurred in 3/118 patients.


CONCLUSIONS
When using pantoprazole plus clarithromycin and metronidazole, the proton pump inhibitor can be used once daily without loss of efficacy.
Bardhan
K D
KD
Rotherham General Hospital, Rotherham, UK. kdbardhan@d-morton.demon.co.uk
Dillon
J
J
Axon
A T
AT
Cooper
B T
BT
Tildesley
G
G
Wyatt
J I
JI
Gatz
G
G
Braun
W
W
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D001944:Breath Tests; D017291:Clarithromycin / Q000627:therapeutic use; D004311:Double-Blind Method; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005756:Gastritis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D009853:Omeprazole / Q000031:analogs & derivatives; D000077402:Pantoprazole; D010349:Patient Compliance; D054328:Proton Pump Inhibitors; D011786:Quality Control; D013454:Sulfoxides / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014508:Urea / Q000378:metabolism
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D001562:Benzimidazoles; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D013454:Sulfoxides; D008795:Metronidazole; D014508:Urea; D000077402:Pantoprazole; D017291:Clarithromycin; D009853:Omeprazole