Eradication of Helicobacter pylori infection with proton pump inhibitor-based triple therapy - A randomised study

Background: Helicobacter pylori (H. pylori) infection plays an important role in the pathogenesis of duodenal ulcer (DU) disease. Low DU recurrences and reinfection rates were universally described, when treatment was effective. It has been suggested that short-term triple therapy, comprising a proton pump inhibitor plus 2 antibiotics (clarithromycin, amoxycillin or a nitroimidazole), should be used as first choice in treating H. pylori infection. Nevertheless, conflicting results have been reported on using these treatment regimens in different countries. Our aim was to compare cure rates of H. pylori infection, with a 1-week triple therapy versus 10 and 15 day triple schedules, in patients with DU. Methods: A total of 172 patients (91 males, mean age 56.2+/- 3.2 years) were randomly treated with a triple therapy including a standard dose of proton pump inhibitor, amoxicillin at a dose of 1 g twice daily and clarithromycin 500 mg twice a day. Sixty-six patients received a 1-week triple therapy (group I), 42 subjects were treated with a 10-day triple therapy (group II) and 64 others with a 14-day triple therapy (group III). H. pylori infection at entry and after eradication, at least 4 weeks after therapy had ended, were assessed by 13C urea breath test and histology on biopsies from the antrum and the corpus. Results: At the end of the course of treatment, the overall H. pylori eradication rate was 68.2% (45/66) in group I, 76.2% (32/42) in group II and 71.9% (46/64) in group III, without any statistically significant difference between the 3 differing period regimens, although a trend for better results with the 10-day triple therapy was observed. Compliance was good and side effects infrequent and mild. Conclusions: None of the 3 periods of triple therapy achieved 80% eradication rate recommended by the Maastricht Consen-sus Conference. The 10-day triple therapy, although not significantly, provided a satisfactory treatment against H. pylori infection.