title: Twice daily (mid-day and evening) quadruple therapy for H. pylori infection in the United States.
abstract: BACKGROUND
  Quadruple therapy provided inadequate eradication rate when given twice-a-day at breakfast and evening meals.
  
  
  OBJECTIVE
  To test twice daily (mid-day and evening) quadruple therapy for Helicobacter pylori eradication.
  
  
  METHODS
  This was a single-centre pilot study in which H. pylori-infected (positive histology and culture and RUT) patients were given 2 x 250 mg of metronidazole and 2 x 250 mg of tetracycline, two Pepto-Bismol tablets, plus one 20 mg rabeprazole tablet twice-a-day for 14 days. H. pylori status was confirmed 4 or more weeks after the end of therapy.
  
  
  RESULTS
  Thirty-seven patients including 3 with peptic ulcer disease, 19 asymptomatic infected, 4 GERD, and 11 with NUD. Mid-day quadruple therapy was successful in 92.3% (95% CI: 79-98%) including 96.2% of those with metronidazole-susceptible strains, and in 83.3% (10/12) of those with metronidazole-resistant H. pylori. Compliance was 100% by pill count except in one individual who stopped medication after 12 days because of side-effects and who failed therapy. Moderate or greater side-effects were experienced by five patients.
  
  
  CONCLUSIONS
  Twice-a-day, mid-day, quadruple therapy proved effective using the combination of bismuth subsalicylate and rabeprazole instead of bismuth subcitrate and omeprazole. Detailed studies of different formulations (e.g. 2 x 250 mg versus 1 x 500 mg of metronidazole or tetracycline) and timing of administration (breakfast and evening meal versus mid-day and evening meals) may result in significant improvements in H. pylori eradication regimens.
authors.affiliation: Veterans Affairs Medical Center, Houston, TX 77030, USA. dgraham@bcm.tmc.edu
authors.forename: D Y
authors.initials: DY
authors.lastname: Graham
authors.forename: G
authors.initials: G
authors.lastname: Belson
authors.forename: S
authors.initials: S
authors.lastname: Abudayyeh
authors.forename: M S
authors.initials: MS
authors.lastname: Osato
authors.forename: M P
authors.initials: MP
authors.lastname: Dore
authors.forename: H M T
authors.initials: HM
authors.lastname: El-Zimaity
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000863:Antacids / Q000008:administration & dosage / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000009:adverse effects; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects; D001729:Bismuth / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009853:Omeprazole / Q000031:analogs & derivatives; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000009:adverse effects; D010349:Patient Compliance; D010865:Pilot Projects; D011446:Prospective Studies; D006180:Proton-Translocating ATPases / Q000037:antagonists & inhibitors; D064750:Rabeprazole; D012459:Salicylates / Q000008:administration & dosage / Q000009:adverse effects; D013752:Tetracycline / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000863:Antacids; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000897:Anti-Ulcer Agents; D001562:Benzimidazoles; D009942:Organometallic Compounds; D012459:Salicylates; D008795:Metronidazole; D064750:Rabeprazole; C015715:bismuth subsalicylate; D006180:Proton-Translocating ATPases; D013752:Tetracycline; D009853:Omeprazole; D001729:Bismuth