Limited usefulness of a seven-day twice-a-day quadruple therapy

Objective To test the usefulness of a twice-a-day. simplified quadruple therapy to cure Helicobacter pylori infection. Design Helicobacter pylori-positive ulcer patients were treated with omeprazole 20 mg twice a day (b.d.), amoxicillin 1 g b.d., tinidazole 500 mg b.d, and bismuth subcitrate 240 mg b.d. for 7 days in an experimental, noncomparative pilot study. Setting The gastroenterology unit of a county hospital. Participants Forty-four consecutive patients with peptic ulcer disease and H. pylori infection. Measurements Cure was tested by either endoscopy or breath test after 2 months, and by urea breath test 6 months after therapy. Results One patient was lost to follow-up. Of the remaining 43, 37 were cured at the first control, giving an intention-to-treat cure rate of 84.1% (95% CI 69-93%) and a per protocol cure rate of 86% (95% CI 71-94%). Thirty-three cured patients agreed to return for a six-month breath test All but one were cured (long-term per protocol cure rate 82.1%; 95% CI 66-92%). Conclusions This particular quadruple therapy is well tolerated and easy to comply with. However, cure rates did not reach 90%. Eur J Gastroenterol Hepatol 12:1315-1318 (C) 2000 Lippincott Williams & Wilkins.