Concomitant Regimen Just as Effective as Sequential Therapy for H-pylori
H pylori is symptomatic in approximately 20% of infected patients and is increasingly resistant to treatment with clarithromycin. Currently, first-line therapies in the United States and Europe achieve eradication rates of only 75% to 80%.
Sequential treatment beginning with a proton pump inhibitor twice daily plus amoxicillin for 5 days, followed by a proton pump inhibitor plus clarithromycin and tinidazole for another 5 days has been demonstrated to have superior efficacy, but this regimen is complicated, long and also, it may be limited by resistance to clarithromycin.
Levofloxacin also has been effective against H pylori. This study compares a 5-day concomitant treatment featuring levofloxacin vs a sequential 10-day regimen.
Patients from a single practice who had evidence of H pylori infection on either 13C urea breath testing or from gastric samples on endoscopy were eligible for study participation. All participants were at least 18 years old and had not received treatment of H pylori previously. All participants were free of major illness, and patients who had used acid suppressive therapy or antibiotics in the 6 weeks before study recruitment were excluded from participation.
Participants were randomly assigned to receive one of 2 regimens to treat H pylori:
Concomitant therapy: esomeprazole 40 mg twice daily plus amoxicillin 1 g twice daily plus levofloxacin 500 mg twice daily plus tinidazole 500 mg twice daily for 5 days.
Sequential therapy: esomeprazole 40 mg twice daily plus amoxicillin 1 g twice daily for 5 days, and then esomeprazole 40 mg twice daily plus levofloxacin 500 mg twice daily plus tinidazole 500 mg twice daily for 5 more days.
Concomitant therapy: esomeprazole 40 mg twice daily plus amoxicillin 1 g twice daily plus levofloxacin 500 mg twice daily plus tinidazole 500 mg twice daily for 5 days.
Sequential therapy: esomeprazole 40 mg twice daily plus amoxicillin 1 g twice daily for 5 days, and then esomeprazole 40 mg twice daily plus levofloxacin 500 mg twice daily plus tinidazole 500 mg twice daily for 5 more days.
The main study outcome was eradication of H pylori, as measured by 13C urea breath testing at 6 weeks and 10 weeks after completion of therapy.
The eradication rates were similar in compairing concomitant (92.2%) vs sequential (93.3%) therapy. The respective erradicatio rates were 96.5% and 95.5%.
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