First-line eradication therapy for Helicobacter pylori in primary health care based on antibiotic resistance: results of three eradication regimens.
OBJECTIVE
To determine the efficacy of three Helicobacter pylori eradication regimens and factors affecting the eradication results in Finland.


METHODS
A total of 342 H. pylori-positive adult patients from primary health care referred for gastroscopy at 23 centres in different parts of Finland were randomized to receive either (i) lansoprazole 30 mg b.d., amoxicillin 1 g b.d. and metronidazole 400 mg t.d.s. (LAM), (ii) lansoprazole 30 mg b.d., amoxicillin 1 g b.d. and clarithromycin 500 mg b.d. (LAC), or (iii) ranitidine bismuth citrate 400 mg b.d., metronidazole 400 mg t.d.s. and tetracycline 500 mg q.d.s. (RMT). A (13)C-urea breath test was performed 4 weeks after therapy.


RESULTS
The eradication result could be assessed in 329 cases. Intention-to-treat cure rates of LAM, LAC, and RMT were 78, 91 and 81%. The difference was significant between LAM and LAC (P = 0.01) and between LAC and RMT (P = 0.04). The eradication rates in cases with metronidazole-susceptible vs. -resistant isolates were for LAM 93% vs. 53% (P = 0.00001), for LAC 95% vs. 84%, and for RMT 91% vs. 67% (P = 0.002). Previous antibiotic use, smoking, and coffee drinking reduced the efficacy of therapy.


CONCLUSIONS
In unselected patients in primary health care, LAC was the most effective first-line eradication.
Koivisto
T T
TT
Department of Internal Medicine, South Karelia Central Hospital, 53130 Lappeenranta, Finland. tarmo.koivisto@mbnet.fi
Rautelin
H I
HI
Voutilainen
M E
ME
Heikkinen
M T
MT
Koskenpato
J P
JP
Färkkilä
M A
MA
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D017291:Clarithromycin / Q000008:administration & dosage; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D015999:Multivariate Analysis; D009853:Omeprazole / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011899:Ranitidine / Q000008:administration & dosage; D012307:Risk Factors
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D064747:Lansoprazole; D008795:Metronidazole; D000658:Amoxicillin; D011899:Ranitidine; D017291:Clarithromycin; D009853:Omeprazole