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Influence of clarithromycin dosage on pantoprazole combined triple therapy for eradication of Helicobacter pylori
Author(s) -
Ellenrieder,
Fensterer,
Waurick,
« Adler,
Glasbrenner
Publication year - 1998
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.1365-2036.1998.00354.x
Subject(s) - pantoprazole , clarithromycin , medicine , helicobacter pylori , pharmacology , gastroenterology , microbiology and biotechnology , omeprazole , biology
Background: Low‐dose clarithromycin (250 mg b.d.) in combination with omeprazole and metronidazole has been recommended for the eradication of Helicobacter pylori . Whether the substitution of omeprazole by pantoprazole requires adjustment of the clarithromycin dose is not known. Aim: To directly compare the efficacy and tolerability of two different dosages of clarithromycin in combination with pantoprazole and metronidazole. Methods: One hundred and sixty‐three patients with endoscopically confirmed gastritis, gastric or duodenal ulcers and positive H. pylori findings in the rapid urease test were randomized and treated for 7 days with pantoprazole (40 mg b.d.), metronidazole (500 mg b.d.) and clarithromycin using either a regimen of 500 mg b.d. (group PMC 500) or 250 mg b.d. (group PMC 250). Eradication success was determined no less than 4 weeks after concluding therapy using the 13 C‐urea breath test. Results: One‐hundred and thirty‐nine patients completed the study. Based on a per protocol analysis, successful eradication was documented in 63/70 patients (90.0%) in group PMC 500 and in 62/69 patients (89.9%) in group PMC 250. Based on the intention‐to‐treat analysis, eradication rates were 78.8% (group PMC 500) and 75.6% (group PMC 250). The incidence of adverse effects was significantly higher in patients receiving PMC 500 (50.0%) than in those receiving PMC 250 (25.4%). Conclusions: Triple therapy with pantoprazole, metronidazole and clarithromycin provides an efficient eradication regimen for H. pylori infection. A low dose of clarithromycin is equal to a higher dose in therapeutic efficacy and it offers the advantage of improved tolerance and lower cost.