High-dose, ten-day esomeprazole, amoxicillin and metronidazole triple therapy achieves high Helicobacter pylori eradication rates
Article first published online: 17 MAY 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 36, Issue 2, pages 190–196, July 2012
How to Cite
Sánchez-Delgado, J., García-Iglesias, P., Castro-Fernández, M., Bory, F., Barenys, M., Bujanda, L., Lisozain, J., Calvo, M. M., Torra, S., Gisbert, J. P. and Calvet, X. (2012), High-dose, ten-day esomeprazole, amoxicillin and metronidazole triple therapy achieves high Helicobacter pylori eradication rates. Alimentary Pharmacology & Therapeutics, 36: 190–196. doi: 10.1111/j.1365-2036.2012.05137.x
- Issue published online: 18 JUN 2012
- Article first published online: 17 MAY 2012
- Manuscript Revised: 25 APR 2012
- Manuscript Accepted: 25 APR 2012
- Manuscript Revised: 15 MAR 2012
- Manuscript Received: 5 MAR 2012
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.
To assess the eradication rate of a new first-line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole and to evaluate tolerance.
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.
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.
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.