Esomeprazole-based one-week triple therapy with clarithromycin and metronidazole is effective in eradicating Helicobacter pylori in the absence of antimicrobial resistance.
OBJECTIVE
This study aimed to investigate the effectiveness of a one-week triple therapy with esomeprazole, clarithromycin and metronidazole for eradication of Helicobacter pylori infection in the absence of antimicrobial resistance.


METHODS
Patients testing positive for H. pylori susceptible to metronidazole and clarithromycin (E-test) were randomized to receive a one-week regimen with either esomeprazole 2 x 20 mg or omeprazole 2 x 20 mg in combination with clarithromycin 2 x 250 mg and metronidazole 2 x 400 mg. Follow-up endoscopy with histology and culture and/or rapid urease test was performed 4-8 weeks after the end of treatment.


RESULTS
Eighty patients were randomized. Helicobacter pylori infection was cured in 38/39 patients of the esomeprazole group and 31/33 patients of the omeprazole group (per protocol 97.4% (95% confidence interval [CI], 86.2-99.9), 93.7% (95% CI, 79.2-99.2), P=0.59); intention-to-treat 90.4% (95% CI: 77.4-97.3), 81.6% (95% CI: 65.7-92.3), respectively. No major side effects occurred. Minor side effects occurred in eight (20%) and six (23%) patients during esomeprazole and omeprazole therapy, respectively. Post-treatment susceptibility testing revealed resistance to both metronidazole and clarithromycin in two of the three patients who failed.


CONCLUSIONS
We conclude that esomeprazole, clarithromycin and metronidazole as one-week triple therapy is effective for eradication of H. pylori in the absence of antimicrobial resistance.
Miehlke
S
S
Medical Department I, Technical University Hospital, Dresden, Germany. miehlke@mk1.med.tu-dresden.de
Schneider-Brachert
W
W
Bästlein
E
E
Ebert
S
S
Kirsch
C
C
Haferland
C
C
Buchner
M
M
Neumeyer
M
M
Vieth
M
M
Stolte
M
M
Lehn
N
N
Bayerdörffer
E
E
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D017291:Clarithromycin / Q000008:administration & dosage; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D064098:Esomeprazole; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage*; D010349:Patient Compliance; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D000897:Anti-Ulcer Agents; D008795:Metronidazole; D017291:Clarithromycin; D009853:Omeprazole; D064098:Esomeprazole