Evaluation of a Four-drug, Three-antibiotic, Nonbismuth-containing "Concomitant" Therapy as First-line Helicobacter pylori Eradication Regimen in Greece

Background: The eradication rates of Helicobacter pylori (H. pylori) with standard treatments are decreasing worldwide as in Greece. Studies with new antibiotic combinations are needed to find better methods of eradication. Therefore, the aim of this study was to evaluate efficacy and tolerability of a 10-day, four-drug, three-antibiotic, nonbismuthcontaining concomitant regimen. Materials and Methods: This is a prospective, open-label, multicenter study that included 131 patients infected with H. pylori. All patients were diagnosed with peptic ulcer disease or nonulcer dyspepsia by endoscopy. H. pylori infection was established by at least two positive tests among rapid urease test, gastric histology, and C-13-urea breath test. For 10 days, all patients received esomeprazole 40 mg, amoxycillin 1000 mg, clarithromycin 500 mg, and metronidazole 500 mg, all b.d. eradication was assessed with 13 C urea breath test 8 weeks after the start of treatment. Intention-to-treat and per-protocol eradication rates were determined. Results: One hundred and twenty-seven of the 131 patients completed the study. At intention-to-treat analysis, the eradication rate was 91.6% ( 95% confidence interval ( CI), 85.5-95.7%). For the per-protocol analysis, the eradication rate was 94.5% ( 95% CI, 89-97.8%). Adverse events were noted in 42 of 131 ( 32.1%); drug compliance was excellent with 96.9% of the patients taking more than 90% of the prescribed medication. Conclusion: A 10-day concomitant regimen appears to be an effective, safe, and well-tolerated treatment option for first-line H. pylori eradication in Greece.