Source: Hypertension  |  Posted 8 years ago

[]Helicobacter pylori[] metronidazole resistance in patients with duodenal ulcers can be largely overcome with a regimen of omeprazole, bismuth biskalcitrate, metronidazole and tetracycline (OBMT).

According to researchers in the United States and Canada, OBMT in a single-triple capsule is as effective and well tolerated as the widely used omeprazole, amoxicillin, and clarithromycin (OAC) regimen.

This multi-centre trial, led by L. Laine from the University of Southern California School of Medicine, Los Angeles, compared the efficacy of bismuth-based quadruple therapy with OBMT, using a single-triple capsule of BMT, versus triple therapy with OAC in treating 275 patients. []H. Pylori[] metronidazole resistance was found in 40% of their subjects.

Two groups were randomly assigned from these subjects who had active duodenal ulcer or were diagnosed within the last five years and with []H. Pylori[] infection recorded by (13)C-urea breath test plus histology or culture.

One group of 138 patients received a 10-day course of OBMT using a single-triple capsule containing bismuth biskalcitrate 140 mg, metronidazole 125 mg, and tetracycline 125 mg, given as three capsules four times a day with twice daily omeprazole 20 mg.

The second group of 137 were given a 10- day course of OAC, omeprazole 20 mg plus amoxicillin 1 g and clarithromycin 500 mg, all twice daily.

Two negative urea breath tests were used to confirm eradication at one and two months.

Rates for modified intent-to-treat eradication for OBMT were 87.7% and 83.2% for OAC (95% CI = -3.9%-12.8%; p = 0.29).

OBMT was found to eradicate 91.7% metronidazole-sensitive and 80.4% metronidazole-resistant strains (p = 0.06). In the OAC group eradication was 92.1% for clarithromycin sensitive and 21.4% clarithromycin-resistant strains (p < 0.001).

Adverse events were seen in 58.5% of OBMT subjects and 59.0% of those in the OAC group.