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High rate of Helicobacter pylori eradication with sequential therapy in elderly patients with peptic ulcer: a prospective controlled study
Author(s) -
Zullo A.,
Gatta L.,
De Francesco V.,
Hassan C.,
Ricci C.,
Bernabucci V.,
Cavina M.,
Ierardi E.,
Morini S.,
Vaira D.
Publication year - 2005
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.1365-2036.2005.02519.x
Subject(s) - medicine , regimen , helicobacter pylori , amoxicillin , clarithromycin , gastroenterology , rapid urease test , rabeprazole , peptic , tinidazole , surgery , gastritis , metronidazole , antibiotics , peptic ulcer , microbiology and biotechnology , biology
Summary Background : Helicobacter pylori eradication rates with triple therapies are decreasing, and few data in elderly patients are available. A 10‐day sequential regimen succeeded in curing such H. pylori infection in unselected patients. Aim : To compare this sequential regimen and the standard triple therapy for H. pylori eradication in geriatric patients with peptic ulcer. Methods : Overall, 179 H. pylori ‐infected patients with peptic ulcer were enrolled (mean age: 69.5 years; range: 65–83). Patients were randomized to 10‐day sequential therapy (rabeprazole 20 mg b.d. plus amoxicillin 1 g b.d. for the first 5 days, followed by rabeprazole 20 mg, clarithromycin 500 mg and tinidazole 500 mg, all b.d., for the remaining 5 days) or standard 7‐day triple regimen (rabeprazole 20 mg, clarithromycin 500 mg and amoxicillin 1 g, all b.d.). Helicobacter pylori status was assessed by histology and rapid urease test at baseline and 4–6 weeks after completion of treatment. Results : The sequential regimen achieved eradication rates significantly higher in comparison with the standard regimen at both intention‐to‐treat (94% vs. 80%; P = 0.008) and per‐protocol (97% vs. 83%; P = 0.006) analyses. In both treatment groups, compliance to the therapy was high (>95%), and the rate of mild side‐effects was similarly low (<12%). At repeated upper endoscopy, peptic ulcer lesions were healed in 97% patients, without a statistically significant difference between the sequential regimen and the standard triple therapy. Conclusions : In elderly patients with peptic ulcer disease, the 10‐day sequential treatment regimen achieved significantly higher eradication rates in comparison with standard triple therapy.