High dose omeprazole plus amoxicillin and azithromycin in eradication of Helicobacter pylori in duodenal ulcers

Abstract

Background. The aim of our study was to establish whether one-week triple therapy regimen (omeprazole, amoxicillin, azithromycin) with low dose (2 × 20 mg/day) or high dose omeprazole (2 × 40 mg/day) is more effective in curing H. pylori infection in patients with active duodenal ulcer disease. Methods. One hundred and twenty patients with duodenal ulcer and H. pylori infection were treated with amoxicillin 2 × 1000 mg/day for the first 7 days plus azithromycin 500 mg/day for the first 6 days. Patients were randomly assigned to receive either omeprazole 2 × 20 mg/day for the first 7 days (group A; n = 60) or omeprazole 2 × 40 mg/day for the first 7 days (group B; n = 60). After 7 days all patients in both groups continued treatment with omeprazole (40 mg/day (days 8-14) and 20 mg/day (days 15-28)). H. pylori status was determined by urease test and histology before the treat-ment and 4 weeks after cessation of any medication. Results. One hundred and thirteen patients completed the study. H. pylori infection was eradicated in 73.2% [41/56] of patients in group A (intention-to-treat [ITT] analysis: 68.3%; 95% CI: 58.6-80.4%) vs. 82.5% [47/57] of patients in group B (ITT analysis: 78.3%; 95% CI: 67.8-87.9%; NS). All ulcers had healed after 4 weeks of omeprazole treatment. Side effects, usually minor, were recorded in 12.5% (group A) and in 14% (group B) of patients (NS), but therapy was discontinued for only one patient in group B (NS). Conclusion. There was no statistically significant difference between one-week triple therapy regimen (omeprazole, amoxicillin, azithromycin) with high dose omeprazole (2 × 40 mg/day) and regimen with low dose omeprazole (2 × 20 mg/day) in curing H. pylori infection in patients with active duodenal ulcer disease. © Blackwell Science, Inc.