Short-term low-dose triple therapy for the eradication of Helicobacter pylori

Background: Helicobacter pylori infection causes antral gastritis and is strongly associated with duodenal ulcer relapse. Eradication of H. pylori infection may be difficult to achieve due to antimicrobial resistance, side effects and poor patient compliance. Objective: To evaluate the efficacy, tolerability and patient compliance of short-term triple therapy with clarithromycin, omeprazole and tinidazole. Methods: Triple therapy, comprising clarithromycin 250 mg twice daily, omeprazole 20 mg once daily and tinidazole 500 mg twice daily, was administered to 65 patients with H. pylori gastritis for 1 week. H. pylori infection before and after treatment was determined by histology, the urease test and the 13C-urea breath test. Upper gastrointestinal endoscopy, during which four antral biopsy specimens were taken, and the 13C-urea breath test were performed in all patients before treatment and at 1 and 6 months after treatment. Drug tolerance was evaluated by patient interviews and compliance by counting returned pills at the end of treatment. Results: Sixty-three patients with H. pylori infection were studied. One month after treatment, on intent-to-treat analysis, H. pylori infection had been eradicated in 62 out of 65 patients (95.4%), confirmed by a negative urease test, 13C-urea breath test and histological examination of antral biopsy specimens. All patients were free of infection 6 months after treatment ended. All but one patient completed treatment and took more than 90% of the prescribed medication. There were no side effects except for one case of mild nausea (not severe enough to stop treatment) and one case of urticaria, following which treatment was withdrawn. Conclusions: Short-term, low-dose triple therapy with clarithromycin, omeprazole and tinidazole is highly effective for the eradication of H. pylori infection. The lack of side effects and good compliance are important for successful eradication.