A randomized comparison of four omeprazole‐based triple therapy regimens for the eradication of Helicobacter pylori in patients with non‐ulcer dyspepsia

Abstract

International guidelines for the management of Helicobacter pylori infection recommend eradication therapy with a proton pump inhibitor and two antibiotics chosen from amoxicillin, a nitroimidazole (metronidazole or tinidazole) and clarithromycin. 1 The use of such triple therapy regimens is underpinned by large randomized trials. In the metronidazole, amoxicillin, clarithromycin, H. pylori, 1-week therapy (MACH 1) study, for example, eradication rates (intention-to-treat analysis) ranged from 75.8% (95% CI, 68.3-83.3) with a twice-daily regimen consisting of omeprazole (20 mg), amoxicillin (1000 mg) and metronidazole (400 mg) given for 1 week, to 90.6% (95% CI, 85.3-95.9) with omeprazole (20 mg) plus amoxicillin and clarithromycin (500 mg each).2 Furthermore, the subsequent MACH 2 study con®rmed that such triple regimens achieve higher eradication rates, reduce the impact of primary antibiotic resistance and may decrease the risk of secondary resistance, compared with regimens consisting of two antibiotics only.3 As a result, such triple regimens now represent the`gold standard' for the eradication of H. pylori.In France, the most widely used triple regimen consists of omeprazole, amoxicillin and clarithromycin. The omeprazole, clarithromycin and metronidazole regimen

2‐Week Triple Therapy for Helicobacter pylori Infection is Better Than 1‐Week in Clinical Practice: a Large Prospective Single‐Center Randomized Study

“…In fact, the design of our randomized investigator-blind study differs from randomized controlled trials in that it is not double blind and this difference could account for less adherence to the protocol. However, in the present investigation, overall patient compliance was found to be good in 91% of cases but, on the other hand, decreasing cure rates, following the recommended 1-week triple therapies, have been reported even more frequently in Europe: 61% in France [30], 67% in Italy [31,32], and 79% in Germany [33]. A meta-analysis [34], including also nonrandomized studies, abstracts, and letters, revealed that the overall H. pylori eradication rate at PP analysis is 71%.…”

H pylori antibiotic resistance: prevalence, importance, and advances in testing

“…In a French study, the rate of secondary resistance was only 23% after azithromycin therapy despite a high failure rate (62%). 51 The impact of erythromycin on selection of resistant strains may be more important. In Iran, the clarithromycin resistance rate is already 17% even though this drug has not been introduced in this country but erythromycin is used.…”

Comparison of Azithromycin and Clarithromycin Triple Therapy Regimens for Helicobacter Pylori Eradication in hemodialysis Patients

“…The eradication rates in this study were found to be 71% and 81%, respectively (19). A fourth study, by Laurent et al, using azithromycin, amoxicillin, and omeprazole, had an eradication rate of 38% (27). In vitro, azithromycin is bactericidal against H. pylori.…”