Helicobacter pylori-positive duodenal ulcer: three-day antibiotic eradication regimen.
BACKGROUND
The most widely used treatments for ulcer healing and Helicobacter pylori eradication consist of a 1-2 week regimen of a proton pump inhibitor plus two or three antimicrobials.


OBJECTIVE
To evaluate the efficacy, safety, cost, and tolerance of a three-day regimen with three antibiotics vs. a 10-day treatment with a proton pump inhibitor or vs. a ranitidine bismuth citrate triple therapy.


METHODS
Two hundred and twenty-one patients with endoscopically-proven H. pylori-positive duodenal ulcers were recruited to the study. Recruited patients were assigned to one of the following four regimens: (I) omeprazole 40 mg o.m. plus amoxycillin 1 g b.d. and clarithromycin 500 mg b.d. for 10 days (OAC: 55 patients); (ii) omeprazole 40 mg o.m. on days 1-5, plus amoxycillin 1 g b.d., clarithromycin 500 mg b.d. and metronidazole 500 mg b.d. on days 3-5 (OACM: 56 patients); (iii) ranitidine bismuth citrate 400 mg b.d. plus amoxycillin 1 g b.d. and clarithromycin 500 mg b.d. for 10 days (RAC: 54 patients); (iv) ranitidine bismuth citrate 400 mg b.d. on days 1-5, plus amoxycillin 1 g b.d., clarithromycin 500 mg b.d. and metronidazole 500 mg b.d. on days 3-5 (RACM: 56 patients). Fisher's exact test was used to compare data regarding healing and eradication in the four groups.


RESULTS
The intention-to-treat eradication and ulcer healing rates for the RACM regimen were 95% and 98%, respectively. Statistically significant differences were observed, relating to the eradication and healing of ulcers, between RACM and either the RAC or OAC regimens.


CONCLUSIONS
The three-day antibiotic therapy with amoxycillin, clarithromycin and metronidazole in addition to ranitidine bismuth citrate is a very effective anti-H. pylori regimen.
Catalano
F
F
Gastroenterology and Digestive Endoscopy Service, University of Catania, Italy. F.Catalano@mbox.unict.it
Branciforte
G
G
Catanzaro
R
R
Cipolla
R
R
Bentivegna
C
C
Brogna
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001729:Bismuth / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D017291:Clarithromycin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D004381:Duodenal Ulcer / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D004791:Enzyme Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D016480:Helicobacter pylori; D006635:Histamine H2 Antagonists / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D010349:Patient Compliance; D010406:Penicillins / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D011899:Ranitidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D004791:Enzyme Inhibitors; D006635:Histamine H2 Antagonists; D010406:Penicillins; D054328:Proton Pump Inhibitors; C073340:ranitidine bismuth citrate; D000658:Amoxicillin; D011899:Ranitidine; D017291:Clarithromycin; D009853:Omeprazole; D001729:Bismuth