Comparison of the efficacy of 14-days concomitant quadruple therapy and 14-days high-dose dual therapy on H pylori eradication
Gastroenterology and Hepatology from Bed to Bench,
Background: Helicobacter pylori (H. pylori) is a gram-negative bacillus that has strong association with chronic gastritis and peptic ulcer disease. H. pylori infection is difficult to treat, and successful treatment requires two or more antimicrobial agents. Different regimens with varying degrees of effectiveness have been used for H. pylori eradication. We compared the efficacy of two different regimens for H. pylori eradication in area with high antibiotic resistance.
Material and Methods: We performed a randomized clinical trial in which 217 patients who had indication for H. pylori eradication were assigned to two groups. One group were taken 14 days concomitant quadruple therapy (pantoprazole 40 mg, amoxicillin 1gr, clarithromycin 500 mg and metronidazole 500 mg every 12 hours for 14 days) and the other group received 14 days high-dose dual therapy, consisted of esomeprazole 40 mg, BID and amoxicillin 1g TDS. H. pylori eradication was assessed eight weeks after end of treatment.
Results: H. pylori eradication rates by per-protocol analysis for 14 days concomitant quadruple therapy and high-dose dual therapy were 88.6% (95% CI, 80.3−92.8) and 82.2% (95% CI, 74.8–89.5), respectively (P = 0.19). Also, according to intention to treat analysis, the eradication rates were 81.6% % (95% CI, 74.5−88.6) and 80.6% (95% CI, 73–88.1), respectively (P = 0.58). The overall drug Side effects was 20.8% in high-dose dual therapy vs. 49.6% in concomitant quadruple therapy. (P < 0.001).
Conclusion: Fourteen days concomitant quadruple therapy can be considered as a relatively acceptable regimen for H. pylori eradication in areas of high clarithromycin and metronidazole resistance. It seems that the high-dose dual therapy could be a promising alternative regimen as the first line H. pylori eradication in these areas.
- H. pylori, High-dose dual therapy, Concomitant quadruple therapy, Eradication
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