Modified seven-day, quadruple therapy as a first line Helicobacter pylori treatment.
BACKGROUND
Cure rates of 7-day triple therapy seem to be decreasing. Quadruple therapies may be an alternative, although their complex administration makes patient acceptance difficult.


OBJECTIVE
To test the usefulness of a thrice a day, quadruple therapy to cure Helicobacter pylori infection.


METHODS
A total of 122 consecutive patients with peptic ulcer and Helicobacter pylori infection were treated with omeprazole 20 mg b.d., tetracycline chlorhydrate 500 mg t.d.s., metronidazole 500 mg t.d.s., and bismuth subcitrate 120 mg t.d.s. administered with meals for 7 days. Cure was tested by either endoscopy or breath test after 2 months, and by urea breath test 6 months after therapy.


RESULTS
Seven patients were lost to follow-up. Of the remaining 115, 110 were cured at the first control, giving an intention-to-treat cure rate of 90.2% (95% CI: 83-95%) and a per protocol cure rate of 95.7% (95% CI: 90-98%). One hundred three patients returned for a 6-month breath test; all but one were cured. Side-effects were minimal or minor in 47 patients (40.8%) and moderate in four (3.4%). Compliance was good, 95% of patients taking more than 90% of the pills. Six (5%) patients stopped treatment after 1, 2, 4 (two patients) and 6 (two patients) days.


CONCLUSIONS
Thrice a day quadruple therapy shows excellent cure rates, far above 90%, is well-tolerated and compliance is easy. Head-to-head comparison with triple therapies as first line Helicobacter pylori treatment seems warranted.
Calvet
X
X
Department of Surgery, Corporació Sanitária Parc Taulí, Sabadell, Spain. xcalvet@cspt.es
Garcia
N
N
Gené
E
E
Campo
R
R
Brullet
E
E
Sanfeliu
I
I
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology; D000897:Anti-Ulcer Agents / Q000008:administration & dosage* / Q000494:pharmacology; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000472:pathogenicity; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage* / Q000494:pharmacology; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage* / Q000494:pharmacology; D009942:Organometallic Compounds / Q000008:administration & dosage* / Q000494:pharmacology; D010349:Patient Compliance; D010437:Peptic Ulcer / Q000188:drug therapy* / Q000382:microbiology; D013752:Tetracycline / Q000008:administration & dosage* / Q000494:pharmacology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D009942:Organometallic Compounds; D008795:Metronidazole; D013752:Tetracycline; C002791:bismuth tripotassium dicitrate; D009853:Omeprazole