Two-week Triple Therapy with either Standard or High-dose Esomeprazole for First-line H. pylori Eradication.
OBJECTIVE
The updated Italian guidelines advise a standard 14-day triple therapy for first-line H. pylori eradication. This prospective study evaluated the cure rate following a 14-day triple therapy with either a standard or double-dose proton pump inhibitor (PPI).


METHODS
A total of 145 consecutive patients with H. pylori infection were randomized to receive a 14-day, first-line triple therapy with clarithromycin 500 mg, amoxicillin 1 g and esomeprazole at either 20 mg (standard therapy) or 40 mg (double-dose therapy), each given twice daily.


RESULTS
At intention-to-treat analysis, H. pylori infection was cured in 73.9% (95% CI: 63.9-84) and 81.9% (95% CI: 73-90.8) following standard and double-dose therapy, respectively, and in 78.2% (95% CI: 68.5-87.9) and 85.5% (95% CI: 77.2-93.8) at per-protocol analysis. No statistically significant difference occurred. Overall, 16.4% and 19.4% patients in the standard and double-dose therapy regimen complained of side effects.


CONCLUSIONS
The success rate of both standard and double-dose 14-day triple therapies for first-line H. pylori treatment was unsatisfactory. A prolonged 14-day levofloxacin-based triple therapy for second-line H. pylori eradication seems to be promising.
Gastroenterology Unit, Riuniti Hospital, Foggia, Italy. vdefrancesco@ospedaliriunitifoggia.it.
Vincenzo
V
De Francesco
Gastroenterology Unit, Sapienza University of Rome, Polo Pontino, Latina, Italy.
Lorenzo
L
Ridola
Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.
Cesare
C
Hassan
Gastroenterology Unit, Riuniti Hospital, Foggia, Italy.
Annamaria
A
Bellesia
Gastroenterology Unit, Sapienza University of Rome, Polo Pontino, Latina, Italy.
Domenico
D
Alvaro
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Dino
D
Vaira
Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.
Angelo
A
Zullo
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage* / Q000009:adverse effects; D017291:Clarithromycin / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D064098:Esomeprazole / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D057194:Intention to Treat Analysis; D007558:Italy; D064704:Levofloxacin / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors; D064704:Levofloxacin; D000658:Amoxicillin; D017291:Clarithromycin; D064098:Esomeprazole