Efficacy of Low - dose Clarithromycin Triple Therapy and tinidazole - containing Triple Therapy forfor Helicobacter pylori Eradication

Choi, Il Ju; Jung, Hyun Chae; Choi, Kyoo Wan; Kim, Jin Ho; Ahn, Deuk Soo; Yang, Ung Suk; Rew, Jong Sun; Lee, Sang In; Rhee, Jong Chul; Chung, In Sik; Chung, Joon Mo; Hong, Weon Seon

Abstract

BACKGROUND/AIMS: Proton pump inhibitor-based triple therapies are recommended as the first-line treatment for Helicobacter pylori (H. pylori) eradication. However, the effect of lowering clarithromycin dose and the efficacy of nitroimidazole-containing regimen in metronidazole-resistance prevalent area are uncertain. The aim of this study was to evaluate the efficacy of low-dose clarithromycin triple therapy and tinidazole-containing triple therapy.
METHODS
This was a randomized multicenter prospective study. A total of 352 patients with duodenal ulcer or non-ulcer dyspepsia patients were randomly divided into 3 groups according to the administered regimen: OAC250 group (omeprazole 20 mg, amoxicillin 1,000 mg, clarithromycin 250 mg), OAC500 group (omeprazole 20 mg, amoxicillin 1,000 mg, clarithromycin 500 mg), and OTC group (omeprazole 20 mg, tinidazole 500 mg, clarithromycin 500 mg). The 3 groups received each regimen twice daily for 7 days. Upper gastrointestinal endoscopy was performed before and 4 weeks after treatment. H. pylori status was determined by the rapid urease test and the 13C urea breath test.
RESULTS
The eradication rates in the OAC2SO, OAC500 and OTC group were 76.2%, 65.7% and 64.8% by intention-to-treat analysis (p=0.149) and 92.8%, 87.2% and 84.1% by per-protocol analysis, respectively (p=0.088). Ulcer-healing rates were not significantly different among the three groups and all regimens were well-tolerated.
CONCLUSIONS
Low-dose clarithromycin triple therapy and tinidazole-containing triple therapy were both effective and safe regimens for H. pylori eradication.