title: High dose amoxicillin-based first line regimen is equivalent to sequential therapy in the eradication of H. pylori infection.
abstract: OBJECTIVE
  Helicobater (H.) pylori eradication rates with standard first-line triple therapy have declined to unacceptable levels. To date, amoxicillin-resistant H. pylori strains have rarely been detected. Whether increasing the dosage of amoxicillin in a standard 7 days eradicating regimen may enhance its efficacy is not known. The aim of this paper is to compare the efficacy of a 7 days high-dose amoxicillin based first-line regimen with sequential therapy.
  
  
  METHODS
  We have retrospectively analyzed data from 300 sex and age matched patients, who underwent 3 different therapeutic schemes: (1) standard LCA, lansoprazole 30 mg bid, clarithromycin 500 mg bid and amoxicillin 1000 mg bid for 7 days; (2) high dose LCA (HD-LCA), lansoprazole 30 mg bid, clarithromycin 500 mg bid and amoxicillin 1000 mg tid for 7 days; (3) sequential LACT, lansoprazole 30 mg bid plus amoxicillin 1000 mg bid for 5 days, followed by lansoprazole 30 mg bid, clarithromycin 500 mg bid and tinidazole 500 mg bid for 5 days. Eradication was confirmed by 13C-urea breath test. Compliance and occurrence of adverse effects were also assessed.
  
  
  RESULTS
  Eradication rates were: 55% for LCA, 75% for HD-LCA and 73% for LACT. Eradication rates were higher in HD-LCA group compared to LCA (p<0.01), while no significant differences were observed in HD-LCA group compared to LACT (p=ns). Compliance and occurrence of adverse effects were similar among groups.
  
  
  CONCLUSIONS
  High-dose amoxicillin based eradicating treatment is superior to standard triple therapy and equivalent to sequential therapy; compared to the latter, the shorter duration may represent an advantage.
authors.affiliation: Internal Medicine Institute and Internal Medicine and Gastroenterology; Catholic University of the Scred heart, Rome, Italy. francesco.franceschi@rm.unicatt.it.
authors.forename: F
authors.initials: F
authors.lastname: Franceschi
authors.forename: V
authors.initials: V
authors.lastname: Ojetti
authors.forename: M
authors.initials: M
authors.lastname: Gabrielli
authors.forename: C
authors.initials: C
authors.lastname: Petruzziello
authors.forename: A
authors.initials: A
authors.lastname: Tortora
authors.forename: G
authors.initials: G
authors.lastname: Gasbarrini
authors.forename: L R
authors.initials: LR
authors.lastname: Lopetuso
authors.forename: F
authors.initials: F
authors.lastname: Scaldaferri
authors.forename: A
authors.initials: A
authors.lastname: Gasbarrini
mesh_terms: D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage* / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001944:Breath Tests; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D064747:Lansoprazole / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D064747:Lansoprazole; D000658:Amoxicillin; D017291:Clarithromycin