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Twice a day quadruple therapy (bismuth subsalicylate, tetracycline, metronidazole plus lansoprazole) for treatment of Helicobacter pylori infection
Author(s) -
GRAHAM D. Y.,
HOFFMAN J.,
ELZIMAITY H. M. T.,
GRAHAM D. P.,
OSATO M.
Publication year - 1997
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.1997.00219.x
Subject(s) - lansoprazole , metronidazole , medicine , helicobacter pylori , tetracycline , gastroenterology , pharmacotherapy , helicobacter , antibiotics , microbiology and biotechnology , biology
Background: Quadruple therapy (bismuth, metronidazole and tetracycline (BMT) + proton pump inhibitor) is touted as being >95% effective, regardless of metronidazole resistance. We tested a 10‐day b.d. quadruple therapy for treatment of H. pylori infection. Methods: Anti‐ H. pylori therapy consisted of lansoprazole 15 mg b.d. plus tetracycline 500 mg b.d., metronidazole 500 mg b.d., and swallowable Pepto‐Bismol caplets (2 b.d.) for 10 days. H. pylori status was evaluated by culture and histology before and 4 or more weeks after therapy. Results: The cure rate for intention‐to‐treat was 70%. Treatment success was calculated overall and separately in relation to antimicrobial resistance patterns. The cure rate among the metronidazole‐sensitive isolates was 89.7% (26 of 29) vs. 41.2% (7 of 17) of the metronidazole‐resistant isolates ( P < 0.005). Moderate ( n = 1) or severe ( n = 3) side‐effects were experienced in four patients with only one withdrawing because of side‐effects. Conclusion: Twice a day quadruple therapy is effective for metronidazole‐sensitive strains but its usefulness is markedly reduced by the presence of pre‐treatment metronidazole resistance. Twice a day quadruple therapy can be recommended in locations where background metronidazole resistance is uncommon. Possibly, 14‐day therapy or a higher dosage of metronidazole provide better results with metronidazole‐resistant H. pylori .