Azithromycin in One Week Quadruple Therapy for H. pylori Eradication

Abstract

Background: In developing countries primary antibiotic-resistance and poor compliance are the main causes of helicobacter pylori (HP) eradication failure of standard regimens. AIM: To investigate eradication rate, patient's compliance and tolerability of a 1-wk Azithromycin based quaruple therapy versus the 2-wk conventional therapy.

Materials and Methods: A total of 129 HP-positive patients were randomized to either omeprazole 20mg, bismuth subcitrate 240 mg, azithromycin 250 mg, metronidazole 500 mg, all twice daily for 1- wk (BOAzM) or omeprazole 20mg, bismuth subcitrate 240 mg, amoxicillin 1g, metronidazole 500 mg all twice daily for 2-wk (B-OAM). HP infection was defined at entry by histology and rapid urease test and cure of infection was determined by negative urea breath test.

Results: HP eradication rates of B-OAzM and B-OAM were74.1% and 70.4% respectively at intention to treat and per-protocol analysis 78.1%versus 75.7% respectively. incidence of poor compliance was lower, although not significant, in patients randomized to B-OAzM than for B-OAM (3.5% versus 4.3 %) but intolerability was similar in two groups ( 35% versus 33.3% ).

Conclusions: 1-wk azithromycin based quadruple regimen achieves an HP eradication rate comparable to that of standard 2-wk quadruple Therapy and is associated with same patient's compliance and complications.