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High-dose, ten-day esomeprazole, amoxicillin and metronidazole triple therapy achieves high Helicobacter pylori eradication rates.

Abstract

BACKGROUND
Strong acid inhibition using esomeprazole increases cure rates with triple therapy and 10-day treatments are more effective than 7-day ones. The combination of amoxicillin plus metronidazole at full doses, and using a physiologically-correct schedule three times a day, and has been shown to overcome metronidazole resistance and to achieve good eradication rates.
AIMS
To assess the eradication rate of a new first-line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole and to evaluate tolerance.
METHODS
Patients from eight hospitals were included. Helicobacter pylori status was assessed by at least one of the following: histology, culture, rapid urease test or urea breath test (UBT). Ten-day treatment was prescribed comprising esomeprazole 40 mg twice a day plus amoxicillin 1 g and metronidazol 500 mg both three times a day. Helicobacter pylori cure was assessed by UBT.
RESULTS
A hundred and thirty-six patients were enrolled. Mean age was 52.6 ± 16 years and 59.6% of patients were men. Main indications for treatment were: uninvestigated dyspepsia (13.6%); functional dyspepsia (18.2%); gastric ulcer (21.8%); and duodenal ulcer (39.8%). Helicobacter pylori eradication was achieved in 112 of the 127 patients who returned for follow-up. Eradication rates were 82.4% (95% CI: 74.7-88.1) by intention-to-treat analysis and 88.2% (95% CI: 81.2-92.8) by per protocol. Treatment was well tolerated and no major side effects were reported. Nine patients complained of mild side effects.
CONCLUSIONS
Cure rates of the combination of esomeprazole, amoxicillin and metronidazole are high and the treatment was well tolerated. This pilot study warrants the comparison of this schedule with current standards.

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  • Publisher Full Text
  • Authors

    Sánchez-Delgado J, García-Iglesias P, Castro-Fernández M, Bory F, Barenys M, Bujanda L, Lisozain J, Calvo MM, Torra S, Gisbert JP, Calvet X

    Institution

    Gastroenterology Unit, Hospital Parc Taulí, Departament de Medicina, Universitat Autònoma de Barcelona, Sabadell, Spain.

    Source

    Alimentary pharmacology & therapeutics 36:2 2012 Jul pg 190-6

    MeSH

    Aged
    Amoxicillin
    Anti-Infective Agents
    Anti-Ulcer Agents
    Breath Tests
    Dose-Response Relationship, Drug
    Drug Administration Schedule
    Drug Therapy, Combination
    Female
    Helicobacter Infections
    Helicobacter pylori
    Humans
    Hydrogen-Ion Concentration
    Male
    Metronidazole
    Middle Aged
    Omeprazole

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22591220