A randomized comparison of four omeprazole-based triple therapy regimens for the eradication of Helicobacter pylori in patients with non-ulcer dyspepsia.
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.
Laurent
J
J
127 rue Saint Dizier, Nancy, France. laurent@polyclinique-essey.com
Mégraud
F
F
Fléjou
J F
JF
Caekaert
A
A
Barthélemy
P
P
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
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