title: A randomized comparison of four omeprazole-based triple therapy regimens for the eradication of Helicobacter pylori in patients with non-ulcer dyspepsia.
abstract: BACKGROUND
  Helicobacter pylori eradication rates in France after therapy with omeprazole, amoxicillin and clarithromycin are among the lowest in Europe. This study evaluated alternative eradication regimens.
  
  
  METHODS
  Helicobacter pylori-positive patients (n=323) with non-ulcer dyspepsia were randomized to receive one of four 1-week regimens consisting of omeprazole, 20 mg b.d., plus either: amoxicillin, 1000 mg b.d., and clarithromycin, 500 mg b.d. (OAC); bacampicillin, 1200 mg b.d., and clarithromycin, 500 mg b.d. (OBC); clarithromycin, 250 mg b.d., and metronidazole, 500 mg b.d. (OCM); or amoxicillin, 1000 mg b.d, and azithromycin, 500 mg on day 1 and 250 mg on days 2-5 (OAAz). Eradication was confirmed by urea breath test 4-6 weeks after treatment. Susceptibility testing was performed in the case of eradication failure.
  
  
  RESULTS
  The eradication rate with OAAz was 38% (95% CI, 25.6-49.4) on intention-to-treat analysis, which was lower (P < 0.05) than with the other regimens [OCM, 61% (50.0-72.8); OBC, 65% (54.0-76.5); OAC, 72% (61.8-81.8)]. Of the strains isolated following treatment failure with OAC, OBC or OCM, 84% were clarithromycin resistant.
  
  
  CONCLUSIONS
  OAC remains the reference treatment for H. pylori eradication in France, although bacampicillin offers a useful alternative to amoxicillin. Susceptibility testing should be considered after unsuccessful eradication therapy.
authors.affiliation: 127 rue Saint Dizier, Nancy, France. laurent@polyclinique-essey.com
authors.forename: J
authors.initials: J
authors.lastname: Laurent
authors.forename: F
authors.initials: F
authors.lastname: Mégraud
authors.forename: J F
authors.initials: JF
authors.lastname: Fléjou
authors.forename: A
authors.initials: A
authors.lastname: Caekaert
authors.forename: P
authors.initials: P
authors.lastname: Barthélemy
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage; D000667:Ampicillin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000494:pharmacology*; D017963:Azithromycin / Q000008:administration & dosage; D001944:Breath Tests; D017291:Clarithromycin / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000473:pathology; D016480:Helicobacter pylori / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D009853:Omeprazole / Q000008:administration & dosage / Q000494:pharmacology*; D010406:Penicillins / Q000008:administration & dosage; D016896:Treatment Outcome; D014508:Urea / Q000032:analysis
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D010406:Penicillins; D008795:Metronidazole; D000667:Ampicillin; D000658:Amoxicillin; D017963:Azithromycin; C011674:bacampicillin; D014508:Urea; D017291:Clarithromycin; D009853:Omeprazole