Authors: GRAHAM, D. Y.; HOFFMAN, J.; EL-ZIMAITY, H. M. T.; GRAHAM, D. P.; OSATO, M.

Source: Alimentary Pharmacology & Therapeutics, Volume 11, Number 5, October 1997 , pp. 935-938(4)

Publisher: Wiley-Blackwell

Abstract:

Background:

Quadruple therapy (bismuth, metronidazole and tetracycline (BMT) + proton pump inhibitor) is touted as being >95% effective, regardless of metronidazole resistance. We tested a 10-day b.d. quadruple therapy for treatment of H. pylori infection. Methods:

Anti-H. pylori therapy consisted of lansoprazole 15 mg b.d. plus tetracycline 500 mg b.d., metronidazole 500 mg b.d., and swallowable Pepto-Bismol caplets (2 b.d.) for 10 days. H. pylori status was evaluated by culture and histology before and 4 or more weeks after therapy. Results:

The cure rate for intention-to-treat was 70%. Treatment success was calculated overall and separately in relation to antimicrobial resistance patterns. The cure rate among the metronidazole-sensitive isolates was 89.7% (26 of 29) vs. 41.2% (7 of 17) of the metronidazole-resistant isolates (P < 0.005). Moderate (n = 1) or severe (n = 3) side-effects were experienced in four patients with only one withdrawing because of side-effects. Conclusion:

Twice a day quadruple therapy is effective for metronidazole-sensitive strains but its usefulness is markedly reduced by the presence of pre-treatment metronidazole resistance. Twice a day quadruple therapy can be recommended in locations where background metronidazole resistance is uncommon. Possibly, 14-day therapy or a higher dosage of metronidazole provide better results with metronidazole-resistant H. pylori.

Document Type: Original article

DOI: http://dx.doi.org/10.1046/j.1365-2036.1997.00219.x

Affiliations: 1: The Department of Medicine, Veterans Affairs Medical Center and the Division of Molecular Virology, Baylor College of Medicine, Houston, Texas, USA

Publication date: 1997-10-01

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