ERADICATION OF HELICOBACTER-PYLORI WITH CLARITHROMYCIN AND OMEPRAZOLE

Clarithromycin, a new and well tolerated, acid stable macrolide antibiotic, has a similar antimicrobial spectrum to erythromycin but a better in vitro MIC90 (0.03 mug/l-1) against Helicobacter pylori (H pylori). This study aimed at determining the eradication rate using clarithromycin 500 mg thrice daily and omeprazole 40 mg daily for two weeks. Patients were given an endoscopy and H pylori status assessed by antral culture (microaerobic conditions, for up to 10 days), antral and corpus histology tests (haematoxylin and eosin/Gimenez stains), and C-13-urea breath test (C-13-UBT, European standard protocol, positive result=excess (deltaCO2)-C-13 excretion >5 per mil). Compliance waa assessed by returned tablet counts. H pylori clearance at the end of treatment and eradication four weeks after finishing treatment were assessed by the C-13-UBT. Seventy three patients (54 men, median age 45 years) with duodenal ulcers (n=42) or duodenitis/non-ulcer dyspepsia (n=31) all with a positive C-13-UBT (mean (SEM) excess (deltaCO2)-C-13 excretion=26.6 (4.9) per mil) and either positive antral histology (n=72) or positive antral culture (n=35) were studied. Before treatment 2/27 (7%) isolates of H pylori were resistant to clarithromycin and five isolates were resistant to metronidazole. In 70/73 (96%) the C-13-UBT was negative immediately after finishing treatment. Four weeks later the C-13-UBT was negative in 57/73 (mean (SEM) excess (deltaCO2)-C-13 excretion=1.2 (0.3) per mil, eradication rate=78%). Forty eight (66%) patients experienced a metallic taste while taking the tablets. Although four (5%) patients, however, could not complete the course of treatment, in only one of these four was H pylori not eradicated. These results show that duel therapy with clarithromycin and omeprazole is well tolerated. With an eradication rate of 78% it is an effective treatment for metronidazole resistant H pylori and may be an alternative to standard triple therapy.