Immediate repeat course of amoxycillin, metronidazole and omeprazole to eradicate Helicobacter pylori

STRÖM, M.
SÖRBERG, M.
JÖNSSON, K.-Å.

Departments of *Internal Medicine and †Clinical Microbiology, Faculty of Health Science, University Hospital of Linköping; ‡Departments of Medico-Surgical Gastroenterology, University Hospital of Linköping, Linköping; and §Department of Infectious Diseases, Danderyd Hospital, Danderyd, Sweden

Accepted for publication 29 October 1996

Correspondence to: Dr M. Ström, Medical Unit, Department of Medico-Surgical Gastroenterology, University Hospital of Linköping, S-581 85 Linköping, Sweden.

Alimentary Pharmacology & Therapeutics 11(2):p 311-316, April 1997.

SUMMARY

Aim:

To investigate a repeat treatment regimen with the same antibiotic combination of amoxycillin and metronidazole in patients with continuing Helicobacter pylori infection.

Methods:

Eighty-two patients with severe peptic ulcer disease and concurrent Helicobacter pylori infection were treated with a two week regimen of omeprazole (40 mg once daily), amoxycillin (750 mg t.d.s.) and metronidazole (400 mg t.d.s.). Upper gastrointestinal tract endoscopy was performed before, and approximately 2 months after, completion of antibiotic therapy. Biopsies were taken for rapid urease testing and the histological demonstration of H. pylori infection. Patients with persistent H. pylori infection at follow-up endoscopy were re-treated with a second and identical antibiotic treatment course. A subsequent endoscopic examination with accompanying biopsies was performed at least 6 weeks after the second treatment course and after a further 6, 18 and 30 months.

Results:

Eradication of H. pylori was achieved in 69 patients (84%, 95% CI: 75-90%) after the first treatment. Four patients (4/82 = 5%) were withdrawn from the study because of side-effects. All of the remaining nine patients had their H. pylori infection eradicated after the second treatment course (95% CI: 70-100%). Seventy-eight patients had a follow-up examination after a median 30 months of the initial eradication of H. pylori, and all but one remained free of infection and none had an ulcer relapse.

Conclusions:

This study demonstrates that patients with persistent H. pylori infection after completing a primary course of omeprazole (40 mg once daily), amoxycillin (750 mg t.d.s.) and metronidazole (400 mg t.d.s.) will probably respond to a repeat course of treatment with the same antibiotic combination.