Eradication ofHelicobacter pyloriwith lansoprazole, roxithromycin and metronidazole—an open pilot study

Abstract

INTRODUCTIONHelicobacter pylori infection is the most common cause of nonautoimmune chronic active gastritis. Almost all duodenal ulcer patients without exposure to nonsteroidal anti-in¯ammatory drugs are infected with H. pylori. It is well known that the eradication of this bacterium heals duodenal ulcers and drastically reduces the relapse rate from over 80% to less than 5% a year. 1 The current popular protocols for H. pylori eradication regimens consist of an acid suppressant (most commonly being omeprazole) and two antibiotics such as clarithromycin and metronidazole (the so-called`Italian triple') or clarithromycin and amoxycillin (`French triple'). 2 The macrolide clarithromycin, element of either regimen, has been documented to be effective against H. pylori in vivo, even in the absence of an acid SUMMARY Background: The most extensively studied Helicobacter pylori eradication regimen comprises omeprazole, clarithromycin and metronidazole. Macrolide antibiotics other than clarithromycin should achieve similar ef®-cacy, but they have not yet been thoroughly tested. Aim: To determine the ef®cacy and safety of a triple therapy regimen using lansoprazole, roxithromycin, and metronidazole on the basis of multicentre outpatient care in an open pilot study. Methods: 163 patients with duodenal ulcer and proven H. pylori infection received lansoprazole 30 mg b.d., roxithromycin 300 mg b.d. and metronidazole 500 mg b.d. for 7 days followed by another 7 days of lansoprazole 30 mg once daily. H. pylori status was determined by urease quick test, histology, microbiology and 13 Curea breath test before starting and at least 4 weeks after completing treatment. Results: 150 patients were available for evaluation; H. pylori was successfully eradicated in 84.7% (127/

Characteristics of diarrhoea in 10 008 users of lansoprazole in daily practice: which co‐factors contribute?

“…So in these patients, as well as in patients with the indication ulcers, the diarrhoea might be caused partly through the use of one of the other prescribed medicines. [13][14][15] This is also demonstrated by the higher current use of oral antibiotics.…”

“…Most of those regimens have diarrhoea as a commonly reported adverse event. [13][14][15] An analysis of all comedications used may lead to identification of patients at risk of developing diarrhoea while taking lansoprazole. In conclusion, this study was set up to investigate characteristics of diarrhoea and to identify the value of co-factors associated with diarrhoea in daily practice of lansoprazole users, including patients of any age with various indications, underlying diseases and use of other medicines.…”

S3-Guideline ”Helicobacter pylori and gastroduodenal ulcer disease” of the German Society for Digestive and Metabolic Diseases (DGVS) in cooperation with the German Society for Hygiene and Microbiology, Society for Pediatric Gastroenterology and Nutrition e. V., German Society for Rheumatology, AWMF-Registration-no. 021 / 001

“…In German children that were included in the study 20 % showed a primary clarithromycin resistance. This is a significantly higher percentage than in studies on German adults [427,428]. Metronidazol resistances were seen more often in children that were born in Asia or Africa (adjusted OR 2.42, 95 % CI 1.6 -3.7).…”

Duodenal ulcer

“…Side effects increase significantly with treatment duration exceeding 10 days. • The data currently available are not sufficient to prove the equivalence with clarithromycin of other macrolides like azithromycin [23,24] or roxithromycin [25]. • The highest cure rates are achieved with two combinations: PPI-clarithromycin-metronidazole, and PPI-clarithromycin-amoxicillin (Table 1).…”