Comparison of one and two weeks of triple therapy for eradication of H. pylori: a randomized, controlled study in a tropical country

Abstract

INTRODUCTION: Resistance of H. pylori to antibiotics may be particularly high in parts of the tropics. Infection may prove difficult to eradicate in such situations, and there is some evidence of benefit in increasing duration of treatment (triple therapy) from one week to two or three weeks. AIM : To assess the efficacy and tolerability of one-week versus two weeks triple therapy for eradication of H. pylori in a Sri Lankan population. METHODS: 82 consecutive patients aged 18–70 years with peptic ulcer disease testing positive for H. pylori infection (histology and rapid urease test on gastric antral biopsies) were randomly allocated to two treatment groups. The baseline characteristics of the two groups were similar. Both groups received omeprazole 20mg, clarithromycin 250mg, and tinidazole 500mg. Group A (n = 42) received the trial medication twice daily for one week and the Group B (n = 40) twice daily for two weeks. H. pylori eradication was defined as a negative 14C labeled urea breath test at two weeks after completion of therapy. The assessors were blind to randomization and other patient information. RESULTS; All patients presented for follow up after completion of therapy. H. pylori infection was eradicated in 36 (85.7%) patients in group A and 36 (90%) patients in group B (p = 0.9; 95% CI: -19.1 to 10.8). 23 (55%) patients in group A and 17 (43%) in group B reported adverse effects attributable to trial medication (p = 0.387); none were serious. 3 (7.5%) patients in group B discontinued treatment due to adverse events that developed on days 7, 9 and 10. CONCLUSION: Twice daily treatment with clarithromycin, tinidazole, and omeprazole for one-week is well tolerated and provides as good a rate of H. pylori eradication as two weeks therapy in Sri Lankan patients.