Comparison of two low-dose one-week triple therapy regimens with and without metronidazole for cure of H-pylori infection

Background: One-week triple therapy consisting of omeprazole 20 mg b.d., clarithromycin 250 mg b.d. and tinidazole 500 mg b.d. is an effective therapy for H. pylori infection with a cure rate of 93%. We therefore compared two similar 1-week regimens consisting of a lansoprazole, clarithromycin and either metronidazole or tetracycline in a prospective study. Methods: Two cohorts, each of 60 patients suffering from H. pylori infection associated with peptic ulcer disease or ulcer-like dyspepsia, were treated for 1 week with either lansoprazole 30 mg b.d., clarithromycin 250 mg b.d. and either metronidazole 400 mg b.d. (cohort A, n = 60) or tetracycline 300 mg b.d. (cohort B, n = 60). Four weeks after treatment, cure of H. pylori infection was evaluated by endoscopy using rapid urease testing together with histology. Results: In cohort A, 55 patients out of 60 showed cure of H. Pylori infection (92%); the treatment was well tolerated, but three patients suffered from side-effects. In cohort B, which was free of metronidazole, 50 out of 60 patients showed cure of H. pylori infection (83%); two patients reported side-effects. The differences between the two cohorts were not statistically significant. Conclusion: Triple therapy for 1 week with lansoprazole as the antisecretory agent seems to be as effective as is reported for omeprazole-based regimens.