Optimal PPI-based triple therapy for the cure of Helicobacter pylori infection: A single center comparison of four 14-day schedules

Background. Helicobacter pylori eradication is accomplished using a wide array of drugs combined in a multitude of dosage schedules. The aim of the present study was to define the best 14-day eradication schedule using a PPI plus either two antibiotics or one antibiotic and bismuth. Material and Methods. For this study, 367 subjects (198 males, 169 females, age 22-87 years) with document H. pylori infection of the stomach were recruited from outpatients of the Gastroenterology Department of the Venezia Hospital. In all patients, H. pylori infection was identified by histology and the CLO-test. Patients were treated as follows: 1) PPI(P) plus clarithromycin (C) 250 mg plus amoxicillin (A) 1000mg bid (P+C+A); 2) P plus C plus bismuth subcitrate (Bi 120 mg qid (P+C+B); 3) P plus C plus tinidazole (T) 500 mg bid (P+C+T); and 4) P plus A plus T bid (P+A+T). After two months, an upper gastrointestinal endoscopy was repeated for end point histological evaluation and the CLO-test. Positivity of one of the two methods was considered sufficient to define H. pylori as "not rradicated". Statistics: Chi-squared test and Fisher exact test. Results. Thirty-three subjects dropped out (six due to adverse events). P+C+B was proven significantly less effective than P+C+A, P+C+T and P+A+T, eradication rates being, respectively, 75.0%, 90.5%, 87.6%, 92.0%, (p = .005, per protocol analysis). Conclusions. All PPI-based triple therapies tested in this study were effective in curing H. pylori infection; however, P+C+B resulted in rates too low (< 85%) to be recommended. P+C+A and P+A+T resulted in the high cure rates and thus may be considered the treatment of choice.