title: High-dose, ten-day esomeprazole, amoxicillin and metronidazole triple therapy achieves high Helicobacter pylori eradication rates.
abstract: BACKGROUND
  Strong acid inhibition using esomeprazole increases cure rates with triple therapy and 10-day treatments are more effective than 7-day ones. The combination of amoxicillin plus metronidazole at full doses, and using a physiologically-correct schedule three times a day, and has been shown to overcome metronidazole resistance and to achieve good eradication rates.
  
  
  OBJECTIVE
  To assess the eradication rate of a new first-line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole and to evaluate tolerance.
  
  
  METHODS
  Patients from eight hospitals were included. Helicobacter pylori status was assessed by at least one of the following: histology, culture, rapid urease test or urea breath test (UBT). Ten-day treatment was prescribed comprising esomeprazole 40 mg twice a day plus amoxicillin 1 g and metronidazol 500 mg both three times a day. Helicobacter pylori cure was assessed by UBT.
  
  
  RESULTS
  A hundred and thirty-six patients were enrolled. Mean age was 52.6 ± 16 years and 59.6% of patients were men. Main indications for treatment were: uninvestigated dyspepsia (13.6%); functional dyspepsia (18.2%); gastric ulcer (21.8%); and duodenal ulcer (39.8%). Helicobacter pylori eradication was achieved in 112 of the 127 patients who returned for follow-up. Eradication rates were 82.4% (95% CI: 74.7-88.1) by intention-to-treat analysis and 88.2% (95% CI: 81.2-92.8) by per protocol. Treatment was well tolerated and no major side effects were reported. Nine patients complained of mild side effects.
  
  
  CONCLUSIONS
  Cure rates of the combination of esomeprazole, amoxicillin and metronidazole are high and the treatment was well tolerated. This pilot study warrants the comparison of this schedule with current standards.
authors.affiliation: Gastroenterology Unit, Hospital Parc Taulí, Departament de Medicina, Universitat Autònoma de Barcelona, Sabadell, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sánchez-Delgado
authors.forename: P
authors.initials: P
authors.lastname: García-Iglesias
authors.forename: M
authors.initials: M
authors.lastname: Castro-Fernández
authors.forename: F
authors.initials: F
authors.lastname: Bory
authors.forename: M
authors.initials: M
authors.lastname: Barenys
authors.forename: L
authors.initials: L
authors.lastname: Bujanda
authors.forename: J
authors.initials: J
authors.lastname: Lisozain
authors.forename: M M
authors.initials: MM
authors.lastname: Calvo
authors.forename: S
authors.initials: S
authors.lastname: Torra
authors.forename: J P
authors.initials: JP
authors.lastname: Gisbert
authors.forename: X
authors.initials: X
authors.lastname: Calvet
mesh_terms: D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage*; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001944:Breath Tests; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D064098:Esomeprazole / Q000008:administration & dosage*; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged
chemical_list: D000890:Anti-Infective Agents; D000897:Anti-Ulcer Agents; D008795:Metronidazole; D000658:Amoxicillin; D064098:Esomeprazole