title: Penbactam for Helicobacter pylori eradication: a randomised comparison of quadruple and triple treatment schedules in an Iranian population.
abstract: OBJECTIVE
  Selection of the best drug regimens for eradication of Helicobacter pylori infection especially in patients at risk of peptic ulcer relapses and the development of complications is challenging. This study assessed and compared the efficacy of the two common PPI based triple therapies to a quadruple therapy including PPI, metronidazole, amoxicillin and a bismuth compound in Iranian population.
  
  
  METHODS
  Three hundred and thirty patients with peptic ulcer and H. pylori infection were included in the study. Patients were randomly assigned to one of the three treatment protocols all given twice daily: (a) A 14-day quadruple therapy (OMAB group) comprising omeprazole 20mg, metronicazole 500 mg, amoxicillin 1g, and bismuth subcitrate 240 mg; (b) A 14-day triple regimen (OCP group) comprising omeprazole 20mg plus clarithromycine 500 mg and penbactam 750 mg and (c) A 14-day triple regimen (OCA group) comprising omeprazole 20mg plus clarithromycine 500 mg and amoxicillin 1g. Cure was defined as a negative urea breath test at least six weeks after treatment.
  
  
  RESULTS
  The per-protocol eradication rates achieved with both OCP regimen (87.0%) and OCA treatment (90.8%) were significantly higher than the OMAB treatment protocol (56.0%); however, no significant difference emerged in eradication rates between the two triple treatment schedules. No significant differences between the groups were found in most side-effects.
  
  
  CONCLUSIONS
  Two-week quadruple therapy showed a lower eradication rate compared to common triple treatment schedules when used as first-line eradication treatment for H. pylori infection in Iranian population.
authors.affiliation: Golestan Research Center of Gastroenterology & Hepatology, Department of Internal Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: Seyedali
authors.initials: S
authors.lastname: Seyedmajidi
authors.forename: Dariush
authors.initials: D
authors.lastname: Mirsattari
authors.forename: Homayoun
authors.initials: H
authors.lastname: Zojaji
authors.forename: Elahe
authors.initials: E
authors.lastname: Zanganeh
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Seyyedmajidi
authors.forename: Shohreh
authors.initials: S
authors.lastname: Almasi
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Zali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000008:administration & dosage; D000667:Ampicillin / Q000008:administration & dosage; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001944:Breath Tests; D017291:Clarithromycin / Q000008:administration & dosage; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D007492:Iran; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage; D009942:Organometallic Compounds / Q000008:administration & dosage; D010437:Peptic Ulcer / Q000188:drug therapy* / Q000382:microbiology; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D013407:Sulbactam / Q000008:administration & dosage; D014508:Urea / Q000032:analysis; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D004338:Drug Combinations; D009942:Organometallic Compounds; D054328:Proton Pump Inhibitors; C585350:penbactam; D008795:Metronidazole; D000667:Ampicillin; D000658:Amoxicillin; D014508:Urea; D017291:Clarithromycin; C002791:bismuth tripotassium dicitrate; D009853:Omeprazole; D013407:Sulbactam