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Digestive Diseases and Sciences

, Volume 50, Issue 3, pp 443–448 | Cite as

Twice-Daily Standard Dose of Omeprazole Achieves the Necessary Level of Acid Inhibition for Helicobacter pylori Eradication. A Randomized Controlled Trial Using Standard and Double Doses of Omeprazole in Triple Therapy

  • G. ManesEmail author
  • O. Pieramico
  • F. Perri
  • D. Vaira
  • N. Giardullo
  • M. Romano
  • G. Nardone
  • A. Balzano
Article

Abstract

Antibiotic resistances and level of acid inhibition may affect the outcome of eradicating regimens for H. pylori. To evaluate the impact of different degrees of acid inhibition on the efficacy of triple treatment, we treated 323 patients with H. pylori infection with clarithromycin and tinidazole plus omeprazole, either 20 mg bid or 40 mg bid. Gastric biopsies and antimicrobial susceptibility testing were performed. Eradication was evaluated by means of breath test. Eradication rates were (intention to treat and per protocol) 83.3 and 84.3% in patients receiving 40 mg omeprazole and 81.9 and 84.1% in those receiving 80 mg omeprazole. Culture was successful in 218 patients (68.7%). Resistance to clarithromycin and metronidazole were found in 13.7 and 20.6%, respectively. Eighteen further patients (8.2%) presented double resistance. Resistance was comparable across the two groups. In resistant patients the eradication rate was significantly lower (66.6% [95% CI, 56–76%], vs 86% [95% CI, 78–91%]; P = 0.001). Antibiotic resistance (OR, 2.73; 95% CI, 1.4–5.3) and smoking (OR, 2.68; 95% CI, 1.4–5.2) were independent predictors of eradication failure. Omeprazole, 20 mg bid, achieves the optimal acid inhibition in H. pylori eradication. Increasing antisecretory activity does not significantly enhance cure rates.

Keywords:

Helicobacter pylori omeprazole antibiotic culture eradication failure triple therapy 

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Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • G. Manes
    • 1
    • 8
    Email author
  • O. Pieramico
    • 2
  • F. Perri
    • 3
  • D. Vaira
    • 4
  • N. Giardullo
    • 5
  • M. Romano
    • 6
  • G. Nardone
    • 7
  • A. Balzano
  1. 1.Department of GastroenterologyCardarelli HospitalNapoli
  2. 2.Department of Internal MedicineTappeiner HospitalMerano
  3. 3.Division of Gastroenterology“Casa Sollievo della Sofferenza” Hospital, IRCCSSan Giovanni Rotondo
  4. 4.Department of Internal MedicineUniversity of BolognaBologna
  5. 5.Department of GastroenterologySan Giovanni Moscati HospitalAvellino
  6. 6.Department of GastroenterologyII University of NapoliNapoliItaly
  7. 7.Department of GastroenterologyUniversity Federico IINapoliItaly
  8. 8.Divisione di GastroenterologiaOspedale CardarelliNapoliItaly

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