Searching for an optimal therapy for H pylori eradication: High‐dose proton‐pump inhibitor dual therapy with amoxicillin vs. standard triple therapy for 14 days

Abstract Background & Aims We compared a high‐dose dual therapy (HDDT) with rabeprazole and amoxicillin and compared it with a standard triple therapy (STT) with rabeprazole, amoxicillin, and clarithromycin for 2 weeks for H pylori eradication in treatment naïve patients. Methods H pylori ‐positive patients were randomly assigned to either a rabeparzole (Pariet) 20 mg b.i.d., amoxicillin (Ospamox) 1 g b.i.d. and clarithromycin (Klacid) 500 mg b.i.d. for 14 days or rabeprazole (Pariet) 20 mg q.i.d., amoxicillin (Ospamox) 1 g q.i.d. also for 14 days. Eradication was tested for by the C 13 ‐UBT at least 4 weeks after the completion of therapy. Results H pylori was eradicated in 86.2% of patients (81/94) (95% CI: 77.8‐91.7) in the STT group compared with 92.8% (90/97) (95% CI: 85.9‐96.5) in the HDDT group on ITT analysis. On PP analysis, H pylori was eradicated in 91.0% of patients (81/89) (95% CI: 83.3‐95.4) in the STT group compared with 93.8% (90/96) (95% CI: 87.0‐97.1) in the HDDT group. Side effects were few although many patients in the STT arm complained of bitter taste. The HDDT arm was well tolerated by patients. Conclusions The HDDT gave a high eradication rate comparable to the STT for 2 weeks and was a well‐tolerated regimen for H pylori eradication.