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Experience with‘triple’ anti‐Helicobacter pylori eradication therapy: side effects and the importance of testing the pre‐treatment bacterial isolate for metronidazole resistance
Author(s) -
BELL G. D.,
POWELL K.,
BURRIDGE S. M.,
PALLECAROS A.,
JONES P. H.,
GANT P. W.,
HARRISON G.,
TROWELL J. E.
Publication year - 1992
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 - 10.1111/j.1365-2036.1992.tb00556.x
Subject(s) - metronidazole , helicobacter pylori , medicine , nausea , vomiting , regimen , tetracycline , gastroenterology , antibiotics , side effect (computer science) , microbiology and biotechnology , biology , computer science , programming language
SUMMARY At the 1990 World Congresses of Gastroenterology, the Working Party on Helicobacter pylori ( H. pylori ) recommended that, in suitable patients, the bacterium should be eradicated using a therapeutic regimen comprising a bismuth salt, tetracycline and metronidazole for two weeks. We have treated 40 patients infected with H. pylori with‘triple’ therapy consisting of 120 mg tripotassium dicitrato bismuthate q.d.s., 500 mg tetracycline q.d.s. and 400 mg metronidazole t.d.s. for two weeks. The success rate, in terms of bacterial eradication, was 19/21 (90.5%) in patients with metronidazole‐sensitive organisms, compared with only 6/19 (31.6%) in patients whose H. pylori were resistant to metronidazole ( P < 0.01). Side effects, particularly diarrhoea and vomiting/nausea, were common: 23/40 patients reported such symptoms during the 14‐day course of therapy. Fifteen of these 23 patients completed the entire 14‐day course, although suffering from significant side effects, while the remaining eight patients had to discontinue the treatment because side effects became intolerable. If a form of triple therapy is going to be widely used to eradicate H. pylori infection, the regimen will have to be simpler, shorter, produce fewer side effects and be more effective in patients with metronidazole‐resistant bacteria.