A randomized controlled trial: efficacy and safety of azithromycin, ofloxacin, bismuth, and omeprazole compared with amoxicillin, clarithromycin, bismuth, and omeprazole as second-line therapy in patients with Helicobacter pylori infection.
BACKGROUND
Helicobacter pylori infection of the stomach is widespread among human populations and is considered to play a major role in the pathogenesis of various diseases such as peptic ulcer, adenocarcinoma, and mucosa associated lymphoid tissue (MALT) lymphoma of the stomach. To increase H. pylori eradication rate without increasing bacterial resistance, various regimens have been recommended. Commonly the association of at least two antibiotics with a proton-pump inhibitor is used. The treatment regimens for second-line therapy, suggested in studies from the western world may not be ideal in Iran.


OBJECTIVE
In this study, we evaluated the safety and efficacy of a new quadruple therapy regimen and compared it with the standard second-line treatment for H. pylori eradication.


METHODS
We selected 220 H. pylori positive patients, with a clear indication of eradication therapy, who did not respond to a 2 weeks treatment with metronidazole, amoxicillin, omeprazole, and bismuth. They were randomized into two groups. Group A (n = 110) were treated with azithromycin, ofloxacin, bismuth, and omeprazole and group B (n = 110) with amoxicillin, clarithromycin, bismuth, and omeprazole for 2 weeks. Four weeks after the end of treatment, urea breath test was performed for all subjects to confirm eradication.


RESULTS
In intention-to-treat analysis, the rate of H. pylori eradication in groups A and B was 77.3% (85/110) and 64.5% (71/110) respectively (p = .027). In per-protocol analysis, the rate of H. pylori eradication in groups A and B was 86.7 and 74.7%, respectively (p = .026). The incidence of poor compliance was lower, although not significantly so, in group A than group B (3.5 vs 4.3%). No major adverse events occurred in both groups.


CONCLUSIONS
Two weeks of treatment with ofloxacin, azithromycin, omeprazole, and bismuth is an effective and safe regimen for H. pylori eradication as second-line therapy.
Minakari
Mohammad
M
Department of Gastroenterology and Hepatology, Isfahan University of Medical Sciences, Isfahan, Iran.
Davarpanah Jazi
Amir Hosein
AH
Shavakhi
Ahmad
A
Moghareabed
Neda
N
Fatahi
Farinaz
F
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001944:Breath Tests; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000009:adverse effects* / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D016896:Treatment Outcome; D014508:Urea / Q000032:analysis; D055815:Young Adult
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D014508:Urea; D009853:Omeprazole