Eradication of Helicobacter pylori by 7-Day Triple-Therapy Regimens Combining Pantoprazole with Clarithromycin, Metronidazole, or Amoxicillin in Patients with Peptic Ulcer Disease: Results of Two Double-Blind, Randomized Studies

• Published in: Helicobacter (Cambridge, Mass.) Vol. 8; no. 6; pp. 626 - 642
• Main Authors: Bochenek, Wieslaw J., Peters, Suzanne, Fraga, Polly D., Wang, Wenjin, Mack, Michael E., Osato, Michael S., El-Zimaity, Hala M. T., Davis, Kelly D., Graham, David Y.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-12-2003
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles; 7-day triple therapy; Adolescent; Adult; Aged; Aged, 80 and over; amoxicillin; Amoxicillin - administration & dosage; Amoxicillin - adverse effects; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Anti-Infective Agents - administration & dosage; Anti-Infective Agents - adverse effects; Anti-Ulcer Agents - administration & dosage; Anti-Ulcer Agents - adverse effects; antibiotics; Benzimidazoles - administration & dosage; Benzimidazoles - adverse effects; clarithromycin; Clarithromycin - administration & dosage; Clarithromycin - adverse effects; Double-Blind Method; Drug Resistance; Drug Therapy, Combination; eradication; Female; Helicobacter Infections - drug therapy; Helicobacter pylori; Humans; Male; metronidazole; Metronidazole - administration & dosage; Metronidazole - adverse effects; Middle Aged; Omeprazole - analogs & derivatives; Pantoprazole; Peptic Ulcer - drug therapy; Peptic Ulcer - microbiology; Sulfoxides - administration & dosage; Sulfoxides - adverse effects; Treatment Outcome
• ISSN: 1083-4389; 1523-5378
• DOI: 10.1111/j.1523-5378.2003.00179.x

ABSTRACT
Aim.  To compare the short‐term (7‐day) safety and efficacy of two triple‐therapy regimens using pantoprazole with those of two dual‐therapy regimens (one with pantoprazole and one without), for Helicobacter pylori eradication in patients with peptic ulcer disease.
Methods.  H. pylori infection was identified by rapid urease (CLOtest), and confirmed by histology and culture. Patients were enrolled into one of two randomized, double‐blind, multicenter, parallel‐group studies. In study A, patients received oral pantoprazole 40 mg, clarithromycin 500 mg, and metronidazole 500 mg (PCM); pantoprazole, clarithromycin and amoxicillin 1000 mg (PCA); or pantoprazole and clarithromycin (PC). In study B, patients received PCM, PCA, PC, or clarithromycin and metronidazole without pantoprazole (CM). Treatments were given twice daily for 7 days. H. pylori status after therapy was assessed by histology and culture at 4 weeks after completing the course of study treatment. Modified intent‐to‐treat (MITT; each study: n = 424, n = 512) and per‐protocol (PP; each study: n = 371, n = 454) populations were analyzed. The MITT population comprised all patients whose positive H. pylori status was confirmed by culture and histology; the PP population comprised patients who also complied with ≥ 85% of study medication doses.
Results.  A total of 1016 patients were enrolled. Cure rates among patients with clarithromycin‐susceptible H. pylori strains were 82 and 86% for PCM, and 72 and 71% for PCA, in studies A and B, respectively. Cure rates among patients with metronidazole‐susceptible H. pylori strains were 82 and 87% for PCM, and 71 and 69% for PCA, in studies A and B, respectively. The combined eradication rates observed with the PCM regimen were superior to those of all other regimens tested. Side‐effects were infrequent and mild.
Conclusions.  PCM had the highest overall eradication rate in these two studies examining 7‐day treatment regimens. All regimens were safe and well tolerated.