Eradication of Helicobacter pylori Using One‐week Triple Therapies Combining Omeprazole with Two Antimicrobials: The MACH I Study

Lind, Tore; Zanten, Sander Veldhuyzen van; Unge, Peter; Spiller, Robin C.; Bayerdörffer, Ekkehard; O’Moráin, Colm; Bardhan, Karna Dev; Bradette, Marc; Chiba, Naoki; Wrangstadh, Michael; Cederberg, Christer; Idström, Jan‐Peter

doi:10.1111/j.1523-5378.1996.tb00027.x

Cited by 517 publications

(491 citation statements)

References 17 publications

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“…In our study, the OMC regimen was particularly disappointing, yielding an eradication rate of only 80.5% (95% CI: 65.1, 91.2%). In the MACH 1 study, 6 using the same treatment regimen, a higher eradication rate of 89.7% (95% CI: 84.2,95.2%) was achieved. The explanation for this inconsistency in eradication rates is not entirely clear.…”

Section: Discussionmentioning

confidence: 97%

“…Laine and co-workers 11 also achieved an eradication rate of 77% on intention-totreat analysis with a 1-week course, but using a higher dose of clarithromycin at 500 mg b.d. In the MACH 1 European multicentre study, 6 a low eradication rate of 79.5% (95% CI: 72.2, 86.8%) was reported on intention-to-treat analysis with a OAC regimen using a low dose of clarithromycin (250 mg b.d.). When a higher dose of clarithromycin (500 mg b.d.)…”

Section: Discussionmentioning

confidence: 99%

“…We have also used a dose of amoxycillin that is lower than is reported in most other studies. In two large proton pump inhibitor (PPI)-triple therapy studies, the MACH 1 study 6 and the UK randomized multicentre study, 12 a 1 g b.d. dose of amoxycillin was used.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of two 1‐week low‐dose omeprazole triple therapies— optimal treatment for Helicobacter pylori infection?

Goh

Parasakthi

Chuah

et al. 1997

Aliment Pharmacol Ther

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Objectives:To determine and compare the efficacy and tolerability of two 1‐week regimen comprising omeprazole, clarithromycin and amoxycillin or metronidazole in the eradication of Helicobacter pylori, and to determine the influence of bacterial resistance to metronidazole and clarithromycin on the outcome of treatment.Patients and methods:Patients with unequivocal evidence of H. pylori infection based on culture, histology and rapid urease test of both antrum and corpus biopsies were recruited for the study. The study was a randomized, investigator‐blind, comparative study. Patients received either omeprazole 20 mg o.m., clarithromycin 250 mg b.d. and amoxycillin 500 mg b.d. (OAC) or omeprazole 20 mg o.m., metronidazole 400 mg b.d. and clarithromycin 250 mg b.d. (OMC) for 1 week. Patients were assessed for successful eradication, which was defined as absence of bacteria in all tests (culture, histology and urease test on both antral and corpus biopsies), at least 4 weeks after completion of therapy.Results:Eighty‐two patients were recruited for the study. Eradication rates on intention‐to‐treat analysis were—OAC: 36/41 (87.8%, 95% CI: 73.8, 95.9); OMC: 33/41 (80.5%, 95% CI: 65.1, 91.2). On per protocol analysis were—OAC: 36/40 (90%, 95% CI: 76.3, 97.2); OMC: 32/38 (84.2%, 95% CI: 68.7, 94.0). All side‐effects encountered were mild and no patient discontinued treatment because of intolerance to medications. The most common side‐effects were altered taste (OAC 31.7%, OMC 53.7%) and lethargy (OAC 14.6%, OMC 19.5%). Pre‐treatment metronidazole resistance was encountered in 34/63 (54.0%) patients. No bacterial strains were found with primary resistance to clarithromycin. Metronidazole resistance did not significantly affect eradication rates. Emergence of resistance to clarithromycin was not seen post‐therapy.Conclusions:Both the OAC and the OMC regimens were convenient and well‐tolerated treatments for H. pylori. However, eradication rates were lower than anticipated.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Comparison of two 1‐week low‐dose omeprazole triple therapies— optimal treatment for Helicobacter pylori infection?

Goh

Parasakthi

Chuah

et al. 1997

Aliment Pharmacol Ther

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“…3 The amoxycillin + clarithromycin and metronidazole + clarithromycin regimens were chosen as controls for the proton pump inhibitor-containing triple therapies. The 14-day omeprazole + amoxycillin regimen was chosen to provide a proton pump inhibitor dual therapy control for the proton pump inhibitor triple therapies.…”

Section: Methodsmentioning

confidence: 99%

“…4 However, US data documenting the ef®cacy of 1-week proton pump inhibitor-based triple therapies are limited. We assessed the ef®cacy and tolerability of the best 1-week triple regimens, based on initial results from the MACH 1 Study, 3 in a large US multicentre study, and compared these triple therapies to dual antibiotic therapies without a proton pump inhibitor (to assess the incremental bene®t of a proton pump inhibitor) as SUMMARY Background: One-week proton pump inhibitor-based triple therapies are very popular in the US despite limited US data documenting ef®cacy. We assessed 1-week proton pump inhibitor triple therapies for Helicobacter pylori, and compared them to dual antibiotic therapies (to assess bene®t of omeprazole) and to omeprazole±amoxycillin (to assess bene®t of clarithromycin) in a large, randomized, US multicentre study.…”

Section: Introductionmentioning

confidence: 99%

A United States multicentre trial of dual and proton pump inhibitor‐based triple therapies for Helicobacter pylori

Laine¹,

Frantz²,

Baker³

et al. 1997

Aliment Pharmacol Ther

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Background: One‐week proton pump inhibitor‐based triple therapies are very popular in the US despite limited US data documenting efficacy. We assessed 1‐week proton pump inhibitor triple therapies for Helicobacter pylori, and compared them to dual antibiotic therapies (to assess benefit of omeprazole) and to omeprazole–amoxycillin (to assess benefit of clarithro‐ mycin) in a large, randomized, US multicentre study. Methods: Healthy subjects who were H. pylori‐positive by rapid serological test and 13C‐urea breath test were randomly assigned to (i) omeprazole (O) 20 mg b.d. + amoxycillin (A) 1 g t.d.s. for 14 days (OA); (ii) A 1 g b.d. + clarithromycin (C) 500 mg b.d. for 7 days (AC); (iii) C 250 mg b.d. + metronidazole (M) 500 mg b.d. for 7 days (CM); (iv) O 20 mg b.d. + C 250 mg b.d. + M 500 mg b.d. for 7 days (MOC); or (v) O 20 mg b.d. + C 500 mg b.d. + A 1 g b.d. for 7 days (OAC). Repeat breath tests were done at 6 weeks to assess H. pylori status. Results: Three hundred and two H. pylori‐positive subjects at 25 centres received medication. Intention‐to‐treat cure rate was significantly higher for OAC (82%) than for MOC (67%), CM (59%), AC (18%) or OA (58%). Per‐protocol cure rates were 85% for OAC and 75% for MOC. Discontinuation of therapy due to a side‐effect occurred in 0–3% of each study group. Conclusions: One‐week twice‐daily triple therapy with omeprazole, amoxycillin and clarithromycin provides the best rate of eradication of the five regimens studied. However, treatment in the US for 7 days may be unable to achieve eradication rates of ≥ 90% with proton pump inhibitor‐based triple therapy.

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Treating Helicobacter pylori

Howden¹,

Hunt²

1998

Archives of Internal Medicine

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Eradication of Helicobacter pylori Using One‐week Triple Therapies Combining Omeprazole with Two Antimicrobials: The MACH I Study

Cited by 517 publications

References 17 publications

Comparison of two 1‐week low‐dose omeprazole triple therapies— optimal treatment for Helicobacter pylori infection?

Comparison of two 1‐week low‐dose omeprazole triple therapies— optimal treatment for Helicobacter pylori infection?

A United States multicentre trial of dual and proton pump inhibitor‐based triple therapies for Helicobacter pylori

Treating Helicobacter pylori

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