Comparative study of Helicobacter pylori eradication rates of twice-versus four-times-daily amoxicillin administered with proton pump inhibitor and clarithromycin: a randomized study.
BACKGROUND
Proton pump inhibitor (PPI)-containing triple therapy with clarithromycin and amoxicillin is now a standard regimen for Helicobacter pylori eradication in Korea. Amoxicillin has time-dependent bactericidal activity against H. pylori; we therefore assumed a dosing schedule of amoxicillin would affect the eradication rate of H. pylori. The purpose of this study was to evaluate and compare the efficacy of different amoxicillin dosing schedules for the eradication of H. pylori.


METHODS
One hundred and eighty-six patients with H. pylori infection were eligible for this study. Patients were randomly assigned to one of two regimens: amoxicillin 1000 mg with clarithromycin 500 mg and omeprazole 20 mg twice daily for 2 weeks (BID group, n = 93), or amoxicillin 500 mg four times daily with clarithromycin 500 mg and omeprazole 20 mg twice daily for 2 weeks (QID group, n = 93). The success of H. pylori eradication was evaluated 4-5 weeks after completing treatment.


RESULTS
Overall eradication rate was 90.3%, and eradication rates were 91.4% in the BID group and 89.2% in the QID group (p = 0.62). Compliances was 95.7% in the BID group and 93.5% in the QID group (p = 0.516); this was the only factor that significantly affected H. pylori eradication in this study. Side effects in both groups were generally mild.


CONCLUSIONS
Amoxicillin regimens with PPI and clarithromycin are found to be equally effective and safe in both the BID and QID groups for H. pylori eradication. Therefore, considering patient's comfort, we recommend a twice daily amoxicillin regimen.
Kim
Seung Young
SY
Division of Gastroenterology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Lee
Sang Woo
SW
Jung
Sung Woo
SW
Koo
Ja Seol
JS
Yim
Hyung Joon
HJ
Park
Jong Jae
JJ
Chun
Hoon Jai
HJ
Lee
Hong Sik
HS
Choi
Jai Hyun
JH
Kim
Chang Duck
CD
Ryu
Ho Sang
HS
D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D017291:Clarithromycin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D007723:Korea; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D000658:Amoxicillin; D017291:Clarithromycin