title: Comparison of azithromycin and clarithromycin in triple therapy regimens for the eradication of Helicobacter pylori.
abstract: OBJECTIVE
  We sought to compare an azithromycin-based regimen with an already established clarithromycin-based regimen in the eradication of Helicobacter pylori infection.
  
  
  METHODS
  A prospective, randomized, blinded comparative analysis was performed on 56 patients with upper GI symptoms who presented to the Gastroenterology Department at the Naval Medical Center Portsmouth. All patients had documented H. pylori infection on endoscopy via rapid urease test and histopathology. Patients were randomized to a treatment arm, which consisted of bismuth, clarithromycin, amoxicillin, and lansoprazole (B-LAC) or one consisting of bismuth, azithromycin, amoxicillin, and lansoprazole (B-LAA). To assess eradication, patients then received repeat endoscopy at 8 wk from entrance into the study. Rapid urease test and histopathology were again used to evaluate infection. Patients recorded all side effects. Comparison between the two groups was made using the chi2 method.
  
  
  RESULTS
  Of the 56 patients included in the study, 27 went on to receive B-LAC, whereas 29 received B-LAA. The per protocol eradication rate was 84.6% with B-LAC and 55.5% with B-LAA (p = 0.021). Under intention to treat analysis, the eradication rates for B-LAC and B-LAA were 81% and 52%, respectively (p = 0.019). There was a significant difference between the two groups in number of subjects using nonsteroidal anti-inflammatory drugs (NSAIDs) (p = 0.013) and a trend toward a difference in histamine-2 (H2) blocker use (p = 0.066). Taking these two variables into account, a logistical regression was performed and continued to show a significant superiority in the B-LAC regimen (p = 0.03).
  
  
  CONCLUSIONS
  The results of our study suggest that B-LAC is superior to B-LAA in the eradication of Helicobacter pylori. Our results also suggest that B-LAA is not a suitable regimen in the treatment of H. pylori because of its substandard eradication rate.
authors.affiliation: Naval Medical Center Portsmouth, Virginia, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Sullivan
authors.forename: Walter
authors.initials: W
authors.lastname: Coyle
authors.forename: Richard
authors.initials: R
authors.lastname: Nemec
authors.forename: Thomas
authors.initials: T
authors.lastname: Dunteman
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000328:Adult; D000863:Antacids / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D017963:Azithromycin / Q000008:administration & dosage*; D001729:Bismuth / Q000008:administration & dosage; D017291:Clarithromycin / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D064747:Lansoprazole; D008297:Male; D009853:Omeprazole / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011446:Prospective Studies; D013272:Stomach Diseases / Q000188:drug therapy / Q000382:microbiology
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000863:Antacids; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D064747:Lansoprazole; D017963:Azithromycin; D017291:Clarithromycin; D009853:Omeprazole; D001729:Bismuth