Low-dose Triple Therapy Research Articles

The Incidence of Torsades de Pointes With Perioperative Triple Antiemetic Administration.

The safety of triple antiemetic therapy consisting of ondansetron, haloperidol, and a steroid, to surgical patients is unknown. To determine the incidence of torsade de pointes (TdP) or death following perioperative administration of triple antiemetic therapy. A retrospective cohort study identified 19,874 patients who received 22,202 doses of triple antiemetics during the 2.5-year time frame from March 4, 2020 to September 7, 2022 for surgical nausea prophylaxis or treatment of nausea. These patients above were cross-matched with an electrocardiogram and adverse outcome database; this identified 226 patients with documentation of a QTc > 450 ms, all ventricular tachycardias including TdP within 48 hours of receiving triple antiemetic therapy, or death within 7 days of receiving ondansetron. There were 3 patients who had documented VT (n = 3), but there were no documented incidents of TdP (n = 0). There were 9 codes called on patients within 48 hours of medication administration, and none of them were due to ventricular arrythmias (n = 0). A total of 11 patients died within 7 days of triple antiemetic therapy. Ten of the 11 deaths were determined to not be from the triple antiemetic. One patient died at home within 24 hours of the procedure of an unknown cause (n = 1). No episodes of TdP were identified in patients receiving triple antiemetic therapy perioperatively, though the cause of death in 1 patient could not be determined. This suggest that low-dose triple antiemetic therapy is low risk for the development of TdP.

S-21-5: COMPARISON OF THIRD-DOSE TRIPLE VERSUS THIRD-DOSE DUAL ANTIHYPERTENSIVE COMBINATION THERAPIES IN PATIENTS WITH ESSENTIAL HYPERTENSION DURING 8-WEEK FOLLOW-UP

Objective: We compared efficacy and safety of low-dose triple versus low-dose dual antihypertensive combination therapies in patients with essential hypertension. Design and method: This trial was a multicenter, randomized, double-blind, parallel, phase II study. After a 4-week placebo run-in period, 243 patients were randomized to the third -dose triple combination (ALC group, amlodipine 1.67 mg + losartan potassium 16.67 mg + chlorthalidone 4.17 mg), third-dose dual combination (AL group, amlodipine 1.67 mg + losartan potassium 16.67 mg), (LC group, losartan potassium 16.67 mg + chlorthalidone 4.17 mg), or (AC group, amlodipine 1.67 mg + chlorthalidone 4.17 mg) for 8 weeks. The primary outcome was to compare the mean changes in systolic blood pressure (SBP) from baseline to week 8. Results: Baseline patient characteristics and blood pressure did not show significant differences among 4 groups. The mean SBP reductions of ALC group, AL group, LC group and AC group were -18.30 ± 13.23, -13.03 ± 13.30, -16.29 ± 12.36, and -13.80 ± 13.21 mmHg at week 8 from baseline, respectively. The ALC group showed significant SBP reductions in comparison to the AL and AC groups at week 4 (p = 0.0097 and p = 0.0179, respectively) and week 8 (p = 0.0170 and p = 0.0357, respectively). The mean diastolic blood pressure (DBP) reduction from baseline was significantly greater in the ALC group when compared to the AL group (-7.93 ± 7.05 and -4.95 ± 7.96 mmHg, respectively, p = 0.0307). The proportion of responders for SBP was significantly greater in the ALC group (42.6%) compared to the AL (22.0%), LC (23.3%) and AC (27.1%) groups (p = 0.0126, 0.0210 and 0.0445, respectively) at week 4. Furthermore, the proportion of responders for SBP and DBP was significantly greater in the ALC group (59.7%) compared to the AL (39.3%) and AC (42.4%) groups (p = 0.0222 and 0.0491, respectively) at Week 8. Study drug-related adverse reactions were rare and did not show significant differences among 4 study groups. Conclusions: Low-dose triple antihypertensive combination therapy when compared to the low-dose dual combination therapies demonstrated early effective BP control without increasing adverse drug reactions in patients with essential hypertension during 8-week follow-up.

S1342 Efficacy of H. pylori Eradication by Low-Dose Rifabutin Triple Therapy (RHB-105) Is Unaffected by BMI: Post-hoc Analysis From Two Phase 3 Trials

S1342 Efficacy of H. pylori Eradication by Low-Dose Rifabutin Triple Therapy (RHB-105) Is Unaffected by BMI: Post-hoc Analysis From Two Phase 3 Trials

A9584 Process evaluation of a pragmatic randomised controlled trial of fixed low-dose triple combination therapy as initial or early therapy for hypertension

A9584 Process evaluation of a pragmatic randomised controlled trial of fixed low-dose triple combination therapy as initial or early therapy for hypertension

The Role of Direct Oral Anticoagulants in Patients With Coronary Artery Disease.

Despite contemporary management, patients with coronary artery disease (CAD) remain at high risk for thrombotic events. Several randomized controlled trials have evaluated the use of direct oral anticoagulants (DOACs) in patients with CAD, including in the setting of acute coronary syndrome (ACS) and stable CAD, and in patients with concomitant atrial fibrillation. Trials of apixaban and dabigatran in patients with ACS demonstrate no benefit with an increased risk of bleeding. Conversely, rivaroxaban at a reduced dose of 2.5 mg twice daily reduced thrombotic events and all-cause mortality when added to dual antiplatelet therapy in patients with ACS. Similarly, the addition of low-dose rivaroxaban to acetylsalicylic acid reduced the risk of thrombotic events in patients with stable CAD. However, the addition of a DOAC to antiplatelet therapy increased the risk of major bleeding. In patients with atrial fibrillation undergoing percutaneous coronary intervention, dual-pathway or low-dose triple therapy regimens including dabigatran or rivaroxaban reduced bleeding risk compared to traditional warfarin-based triple therapy, although it remains unclear whether these regimens preserve antithrombotic efficacy. DOAC-based antithrombotic regimens prove useful in patients with CAD in various settings; however, careful selection of patients and regimens per trial protocols are critical to achieving net benefit.

Fixed Low-Dose Triple Combination Antihypertensive Medication vs Usual Care for Blood Pressure Control in Patients With Mild to Moderate Hypertension in Sri Lanka

Poorly controlled hypertension is a leading global public health problem requiring new treatment strategies. To assess whether a low-dose triple combination antihypertensive medication would achieve better blood pressure (BP) control vs usual care. Randomized, open-label trial of a low-dose triple BP therapy vs usual care for adults with hypertension (systolic BP >140 mm Hg and/or diastolic BP >90 mm Hg; or in patients with diabetes or chronic kidney disease: >130 mm Hg and/or >80 mm Hg) requiring initiation (untreated patients) or escalation (patients receiving monotherapy) of antihypertensive therapy. Patients were enrolled from 11 urban hospital clinics in Sri Lanka from February 2016 to May 2017; follow-up ended in October 2017. A once-daily fixed-dose triple combination pill (20 mg of telmisartan, 2.5 mg of amlodipine, and 12.5 mg of chlorthalidone) therapy (n = 349) or usual care (n = 351). The primary outcome was the proportion achieving target systolic/diastolic BP (<140/90 mm Hg or <130/80 mm Hg in patients with diabetes or chronic kidney disease) at 6 months. Secondary outcomes included mean systolic/diastolic BP difference during follow-up and withdrawal of BP medications due to an adverse event. Among 700 randomized patients (mean age, 56 years; 58% women; 29% had diabetes; mean baseline systolic/diastolic BP, 154/90 mm Hg), 675 (96%) completed the trial. The triple combination pill increased the proportion achieving target BP vs usual care at 6 months (70% vs 55%, respectively; risk difference, 12.7% [95% CI, 3.2% to 22.0%]; P < .001). Mean systolic/diastolic BP at 6 months was 125/76 mm Hg for the triple combination pill vs 134/81 mm Hg for usual care (adjusted difference in postrandomization BP over the entire follow-up: systolic BP, -9.8 [95% CI, -7.9 to -11.6] mm Hg; diastolic BP, -5.0 [95% CI, -3.9 to -6.1] mm Hg; P < .001 for both comparisons). Overall, 419 adverse events were reported in 255 patients (38.1% for triple combination pill vs 34.8% for usual care) with the most common being musculoskeletal pain (6.0% and 8.0%, respectively) and dizziness, presyncope, or syncope (5.2% and 2.8%). There were no significant between-group differences in the proportion of patient withdrawal from BP-lowering therapy due to adverse events (6.6% for triple combination pill vs 6.8% for usual care). Among patients with mild to moderate hypertension, treatment with a pill containing low doses of 3 antihypertensive drugs led to an increased proportion of patients achieving their target BP goal vs usual care. Use of such medication as initial therapy or to replace monotherapy may be an effective way to improve BP control. anzctr.org.au Identifier: ACTRN12612001120864; slctr.lk Identifier: SLCTR/2015/020.

TRIple pill vs Usual care Management for Patients with mild-to-moderate Hypertension (TRIUMPH): Study protocol

Hypertension management strategies have traditionally focused on "tailored therapy" and "stepped-care" approaches. These tend to be costly and time consuming and often fail to achieve adequate blood pressure (BP) control. The TRIUMPH study aims to investigate the effectiveness, cost-effectiveness, and acceptability of early use of a 3-in-1 BP-lowering pill ("Triple Pill") compared with usual care for the management of hypertension. The prospective, open, randomized controlled clinical trial (n = 700) will compare Triple Pill-based strategy to usual care among individuals with persistent mild-to-moderate hypertension (systolic BP >140 mm Hg and/or diastolic BP >90 mm Hg, or systolic BP >130 mm Hg and/or diastolic BP >80 mm Hg in patients with diabetes or chronic kidney disease) on no or minimal drug therapy. The study will be conducted within approximately 20 hospital-based clinics in India. Participants will be randomized to the Triple Pill (initially strength 1-telmisartan 20 mg, amlodipine 2.5 mg, hydrochlorothiazide 6.25 mg, with the option of subsequent titration to strength 2-telmisartan 40 mg, amlodipine 5 mg, hydrochlorothiazide 12.5 mg) or continued usual care. Participants will be followed up for 6 months. The primary outcome is the proportion of participants achieving target BP at the end follow-up. This study will determine whether early use of a low-dose triple combination therapy has the potential to address some of the challenges in hypertension control through earlier achievement of BP control, better adherence, and fewer adverse effects, in the context of less intensive clinical follow-up.

Effect of Low-Dose Triple Therapy Using Gabapentin, Amitriptyline, and a Nonsteroidal Anti-Inflammatory Drug for Overactive Bladder Symptoms in Patients With Bladder Pain Syndrome

PurposePatients with bladder pain syndrome/interstitial cystitis (BPS/IC) can have pain as a main symptom and overactive bladder (OAB) symptoms that are directly or indirectly related to a major mechanism that causes pain. The primary purpose of this study is firstly to identify the prevalence rate of OAB symptoms in patients with BPS/IC, secondly to identify changes in OAB symptoms after low-dose triple therapy, and thirdly to build a theoretical foundation to improve quality of life for patients.MethodsPatients who met the inclusion criteria of BPS/IC through basic tests including the O'Leary-Sant symptom index, overactive bladder symptom score (OABSS), and visual analog scale (VAS) were identified. Treatment-based changes in OAB symptoms were identified using the IC Symptom Index and IC Problem Index (ICSI/ICPI), OABSS, and VAS before, and 4 and 12 weeks after low-dose triple therapy.ResultsThe patients consisted of 3 men and 20 women, and their mean age was 61.9 years (41.0-83.2 years). Comparing values before treatment, and 4 and 12 weeks after treatment (baseline vs. 4 weeks to baseline vs. 12 weeks), the rates of improvement were as follows: ICSI, 44.2% to 63.7%; ICPI, 46.9% to 59.4%; OABSS, 34.3% to 58.2%; and VAS, 53.6% to 75.0%, which showed statistically significant differences (P<0.05). However, comparing values at 4 and 12 weeks after treatment (4 weeks vs. 12 weeks), the ICSI and VAS showed a statistically significant decrease (P<0.05). The ICPI and OABSS showed slight improvement, but no statistically significant differences (P>0.05).ConclusionsLow-dose triple therapy in BPS/IC results in a clear decrease in OAB symptoms in the first 4 weeks after treatment, and additional treatment for 8 weeks had a partial effect with varied statistical significances depending on the questionnaires.

Management of Helicobacter pylori-related disorders

The discovery of Helicobacter pylori has opened new opportunities in the management of gastrointestinal disorders, with the cure of chronic ulcer disease now being possible for the first time. The 1994 United States National Institutes of Health Consensus Conference recommended that patients with duodenal or gastric ulcers unrelated to the use of non-steroidal anti-inflammatory drugs (NSAID) should be given eradication therapy. These guidelines were refined at a conference held recently in Maastricht. The updated guidelines strongly recommend treatment in patients with duodenal or gastric ulcer disease, low-grade mucosa-associated lymphoid tissue (MALT) gastric lymphoma, gastritis with severe macro-or microscopic changes and after resection of early gastric cancer. Despite a lack of hard scientific evidence, the guidelines also suggest that eradication treatment is advisable in patients with unequivocally diagnosed functional dyspepsia, a family history of gastric cancer, long-term treatment with proton-pump inhibitors for gastro-oesophageal reflux disease (GORD), planned or existing NSAID treatment, after gastric surgery for ulcer or cancer, or if the patient wants to be treated. Many different therapeutic regimens have been used previously, but at present the best treatment is proton-pump inhibitor-based triple therapy, comprising a proton-pump inhibitor plus two drugs out of clarithromycin, a nitroimidazole and amoxycillin. One-week low-dose triple therapy cures 85-95% of infected patients.

Effects of a Short Course of Oral Prednisolone in Patients with Bladder Pain Syndrome with Fluctuating, Worsening Pain despite Low-Dose Triple Therapy

PurposeTriple therapy with gabapentin, amitriptyline, and nonsteroidal antiinflammatory drugs is efficacious for chronic bladder pain syndrome/interstitial cystitis (BPS/IC). However, transient, fluctuating, worsening pain or flare-up symptoms may develop during treatment for a variety of reasons. Here, we assessed the validity of our observational experience regarding a short course of oral prednisolone therapy, which might be of value in the management of flare-up symptoms of BPS/IC.MethodsBetween May 2007 and May 2012, 7 women (mean age, 61.5 years; range, 44.8 to 75.4 years) with BPS/IC presenting with transient, fluctuating, worsening pain as a flare-up symptom despite low-dose triple therapy received a 1- to 3-month course of oral prednisolone 10 mg. The outcome measures used were the IC symptom scale (ICSS, O'Leary-Sant Interstitial Cystitis Symptom Index) and a visual analogue scale (VAS), which were completed at baseline and after treatment.ResultsThere were statistically significant differences in the ICSS and VAS score before and after prednisolone treatment (P<0.05 by Wilcoxon singed-rank test). The pretreatment IC symptom index (ICSI), IC problem index (ICPI), and VAS score were 16.7± 2.2, 13.7±2.3, and 8.3±1.5 (mean±standard deviation [SD]), and the posttreatment scores were 4.9±2.3, 4.3±1.1, and 2.5±0.9 (mean±SD), respectively. The ICSI, ICPI, and VAS scores were improved after prednisolone treatment by 70.7%, 68.6%, and 69.9%, respectively. Low-dose triple therapy with prednisolone caused no significant adverse effects.ConclusionsIn patients with BPS/IC who show transient, fluctuating, worsening pain as flare-up symptoms despite undergoing low-dose triple therapy, a short course of oral prednisolone therapy was sufficiently effective. However, large-scale studies should be performed to verify our findings.

Helicobacter pylori eradication with a 7-day low-dose triple therapy in hemodialysis patients

The optimal therapeutic regimen for Helicobacter pylori (H. pylori) infection has not been established in end-stage renal disease (ESRD) patients receiving hemodialysis. We investigated the efficacy and safety of a 7-day omeprazole-based triple therapy with low doses of amoxicillin and clarithromycin (OAC) for eradication of H. pylori infection in ESRD patients receiving hemodialysis. Thirty-three hemodialysis patients and 55 patients with normal renal function underwent upper gastrointestinal endoscopy. For eradication of H. pylori infection, a 7-day triple therapy with low-dose OAC (omeprazole 40mg daily, amoxicillin 500mg daily, and clarithromycin 500mg daily) regimen was used. Four weeks after the completion of the OAC regimen, the success of the H. pylori eradication therapy was determined by histological examination and rapid urease test. The prevalence of H. pylori infection was 36.4% in hemodialysis patients and 65.5% in non-uremic patients (p=0.0150). The mean duration of hemodialysis in H. pylori-positive and -negative patients was 56.8±26.9 versus 66.4±26.1months, respectively (p=0.3196). Eradication was successful in 83.4% of hemodialysis patients and 81.0% of non-uremic patients (p=1.000). All patients completed the eradication therapy without any serious adverse effects. A 7-day triple therapy with a low-dose OAC regimen was effective and safe for eradication of H. pylori infection in hemodialysis patients.

M1077 The Efficacy of Adding Sofalcone to One-Week, Low-Dose Triple Therapy for Helicobacter pylori Eradication in Patients with Chronic Gastritis

M1077 The Efficacy of Adding Sofalcone to One-Week, Low-Dose Triple Therapy for Helicobacter pylori Eradication in Patients with Chronic Gastritis

Comparison between quadruple therapy with lactoferrin and low-dose levofloxacin-based triple therapy for H. pylori eradication: Preliminary results of a multicenter study

Comparison between quadruple therapy with lactoferrin and low-dose levofloxacin-based triple therapy for H. pylori eradication: Preliminary results of a multicenter study

Open-label study of a regimen consisting of 1 week of lansoprazole, clarithromycin, and amoxicillin followed by 3 weeks of lansoprazole in healing peptic ulcer and eradicating Helicobacter pylori

ObjectiveThe aim of the study was to assess the efficacy of a regimen consisting of 1 week of low-dose triple therapy with lansoprazole, amoxicillin, and clarithromycin followed by lansoprazole alone for an additional 3 weeks in the eradication of Helicobacter pylori and the healing of peptic ulcer. MethodsPatients aged ≥16 years with active peptic ulcer diagnosed by endoscopy and H pylori infection were eligible for this prospective, open-label, 3-center study. A triple-drug regimen was used that consisted of lansoprazole 30 mg once daily, amoxicillin 1 g BID, and clarithromycin 250 mg BID for 7 days. Ulcer healing and H pylori eradication were assessed endoscopically 8 to 9 weeks after the start of treatment. H pylori was determined to be eradicated if both histologic examination and rapid urease testing (4 biopsy samples, antrum [2] and body [2]) were negative. ResultsFifty-five patients who tested positive for H pylori, 49 with duodenal ulcer (DU) and 6 with gastric ulcer (GU), aged 16 to 78 years, were enrolled in the study. Ten patients were lost to follow-up and 1 withdrew from the study because of side effects; 44 patients were included in the per-protocol analyses. H pylori was eradicated in 34 patients, 62% (95% CI, 0.477ȁ0.746) and 77% (95% CI, 0.662ȁ0.885) in the intent-to-treat and perprotocol analyses, respectively. Ulcers were healed in a total of 38 patients (34 DU, 4 GU), 69% in the intent-to-treat population (95% CI, 0.552ȁ0.809) and 86% in the per-protocol population (95% CI, 0.727ȁ0.948). In patients with DU, the rate of healing was 69% in the intent-to-treat analysis (95% CI, 0.546ȁ0.817) and 89% in the per-protocol analysis (95% CI, 0.752ȁ0.971). ConclusionsOne week of therapy with lansoprazole 30 mg once daily, amoxicillin 1 g BID, and clarithromycin 250 mg BID, followed by 3 weeks of treatment with lansoprazole 30 mg once daily, effectively healed peptic ulcer but was only moderately effective in eradicating H pylori.

One-week low-dose lansoprazole triple therapy for eradication of Helicobacter pylori: A large multicentre, randomised trial

One-week low-dose lansoprazole triple therapy for eradication of Helicobacter pylori: A large multicentre, randomised trial

Pantoprazole Suppresses Helicobacter pylori Without Affecting Cure

Short-term, low-dose triple regimens composed of proton-pump inhibitors (PPI) and two antibiotics are the current gold standard therapy for cure of Helicobacter pylori infection. To date, the effect of PPI pretreatment on eradication outcome is not known. The aim of this study was to evaluate the influence of pretreatment with pantoprazole on the efficacy of an ensuing triple therapy. In this open, randomized, monocenter, parallel group comparison, 107 patients with duodenal ulcer or functional dyspepsia were assigned to receive one of the following treatment regimens: a 7-day triple therapy with pantoprazole, 40 mg bid; clarithromycin, 250 mg bid; and metronidazole, 400 mg bid, which was either preceded or followed by a 7-day therapy with pantoprazole, 40 mg (P-PCM or PCM-P). Assessment of H. pylori status was performed by a biopsy urease test and 13C urea breath test at the initial visit and 13C urea breath test at all follow-up visits. The 7-day pantoprazole pretreatment resulted in a significant decline of the delta values of the 13C urea breath test. H. pylori infection was cured in 47 of 52 intention-to-treat patients of the P-PCM group (90%; 95% confidence interval, 79-97%) and in 46 of 53 of the PCM-P group (87%; 95% confidence interval, 75-95%). Pretreatment with pantoprazole suppresses H. pylori but does not impair the efficacy of a consecutive short-term, low-dose triple therapy.

Short-term treatment with amoxycillin, clarithromycin and lansoprazole during Helicobacter pylori infection in children.

The optimal treatment of Helicobacter pylori (H. pylori) infection in children is still being looked for, although several points can now be made, such as the banning of bismuth in several countries, including France, the need for a dual antibiotic association, due to increasing resistance rates of H. pylori to metronidazole [1Cayla R Lamouliatte H Megraud F et al.Resistance primaire de Helicobacter pylori vis-à-vis du metronidazole et de la clarythromycine dans un centre d'endoscopie hospitalier Bordelais en 1993.Gastroenterol Biol Clin. 1994; 18: A130Crossref Scopus (12) Google Scholar]. and the therapeutic breakthrough provided by proton pump inhibitors (PPIs) in adults [2Bazzoli F Zagari RM Fossi S et al.Short term low-dose triple therapy on the eradication of Helicobacter pylori.Eur J Gastroenterol Hepatol. 1994; 6: 773-777Crossref Scopus (329) Google Scholar] as well as in children [3Kalach N Benhamou PH Raymond J et al.Spiramycin as an alternative to amoxicillin treatment associated with lansoprazole/metronidazole for Helicobacter pylori infection in children.Eur J Pediatr. 1998; 157: 607-608Crossref PubMed Scopus (10) Google Scholar]. In a previous study, we showed that PPIs in association with metronidazole and amoxycillin or macrolide yielded an eradication rate of 85.7% [3Kalach N Benhamou PH Raymond J et al.Spiramycin as an alternative to amoxicillin treatment associated with lansoprazole/metronidazole for Helicobacter pylori infection in children.Eur J Pediatr. 1998; 157: 607-608Crossref PubMed Scopus (10) Google Scholar] to be compared to 100% [4Israel D Hassall E Treatment and long-term follow-up of Helicobacter pylori-associated duodenal ulcer disease in children.J Pediatr. 1993; 123: 53-58Abstract Full Text PDF PubMed Scopus (71) Google Scholar] in a slightly earlier study. A recent trend seems to favor a new macrolide, namely clarithromycin, a molecule more acid-stable than erythromycin and with excellent activity in vitro, which provides an excellent eradication rate in adults [5Logan RPH Gummett PA Hegart YBT Clarithromycin and omeprazole for Helicobacter pylori.Lancet. 1992; 337: 39Google Scholar] with a 1-week-duration treatment [2Bazzoli F Zagari RM Fossi S et al.Short term low-dose triple therapy on the eradication of Helicobacter pylori.Eur J Gastroenterol Hepatol. 1994; 6: 773-777Crossref Scopus (329) Google Scholar]. Recently, in children, a 2-week treatment combining clarithromycin with metronidazole and omeprazole provided an effective eradication rate of 93% with full compliance [6Dohil R Israel DM Hassall E Effective 2 week therapy for Helicobacter pylori disease in children.Am J Gastroenterol. 1997; 92: 244-247PubMed Google Scholar], The purpose of this study was to investigate, through an open study, the potential of clarithromycin in association with amoxycillin and lansoprazole administered in a 1-week treatment in children with proven H. pylori gastric infection. The study involved 25 children, 19 girls and six boys, aged 13.5±2.6 years (range 8–16 years), with H. pylori gastric infection proved by endoscopic, histologic and/or culture samples. Culture was positive in 15, with H. pylori strains susceptible to amoxycillin in all, resistant to metronidazole in nine (60%), and resistant to clarithromycin in two (13.3%). Children were treated for 8 days with lansoprazole 1 mg/kg per day, maximum 30 mg, clarithromycin 7.5 mg/kg b.i.d. (twice daily), maximum 500 mg b.i.d. and amoxycillin 50 mg/kg b.i.d., maximum 1 g b.i.d. As assessed by a 13C[urea] breath test [7Kalach N Briet F Raymond J et al.Time course analysis and simplification of the 13C-urea breath test in the detection of Helicobacter pylori in children.J Pediatr Gastroenterol Nutr. 1998; 26: 291-296Crossref PubMed Scopus (73) Google Scholar] performed 6 weeks following discontinuation of therapy, the infection was eradicated in 23 children (92%; 95% confidence interval, 0.11, 0.36). Four children only exhibited transient side effects; two children exhibited vomiting and the other two had abdominal pain. Therapeutic compliance was excellent–that is, all the children took more than 90% of the drugs. H. pylori infection was not eradicated in only two children. One exhibited primary clarithromycin-resistant strains and the other had a positive histology with a negative culture, preventing any determination of sensitivity to antibiotics. Furthermore, H. pylori infection was also eradicated in the second child who exhibited primary clarithromycin-resistant strains. This study underlines an excellent eradication rate with the proposed short-term triple association and further assesses the increasing rate of metronidazole resistance of H. pylori strains, contrasting with the low rate observed with clarithromycin.

My approach to Helicobacter pylori eradication

The eradication of Helicobacter pylori is advantageous in many diseases of the upper gastrointestinal tract and can result in the cure of conditions such as peptic ulcer disease. It may also potentially prevent the development of gastric cancer. Complete eradication of H. pylori can be difficult to achieve, and the effectiveness of many combinations of agents has been tested in clinical trials over the years. No agent has been found to be effective at eradicating H. pylori when given alone and this has resulted in the development of combination therapies comprising an antisecretory agent and one or more antibiotics. Bismuth-based triple therapies, while considered for years as the 'gold standard', have limited efficacy and may be associated with significant side effects. Dual therapies, comprising a proton pump inhibitor (PPI) and one antibiotic, marked a milestone in the history of H. pylori eradication therapy but have shown inconsistent results and eradication rates of less than 60%. However, these have provided the basis for the development of short-term, low-dose PPI triple therapies, including two antibiotics from among metronidazole, clarithromycin and amoxycillin plus a PPI that have demonstrated excellent eradication rates approaching 100%.

Eradication of Helicobacter pylori by means of a low-dose one-week triple therapy containing pantoprazole, clarithromycin and methonidazole

Eradication of Helicobacter pylori by means of a low-dose one-week triple therapy containing pantoprazole, clarithromycin and methonidazole

Helicobacter pylori eradication in clinical practice: one-week low-dose triple therapy is preferable to classical bismuth based triple therapy.

Both classical 2-week bismuth based triple therapy and the newer 1-week low-dose omeprazole based triple therapies achieve high Helicobacter pylori eradication rates in controlled clinical trials and are in widespread use in routine clinical practice. However, their efficacy and acceptability in this setting is unproved. Over a 1-year period, the notes for patients attending a dedicated H. pylori treatment clinic were audited. Assessments were made of patient demographics, diagnosis, smoking habits, use of H2-antagonists, regimen used, efficacy of treatment, compliance and side-effects experienced. 223 sets of notes were audited. 89 patients received bismuth, tetracycline and metronidazole for two weeks and 111 patients received omeprazole, clarithromycin and either metronidazole (63 patients) or tinidazole (48 patients) for 1 week. Successful eradication was achieved in 75/89 (84.3%), 56/63 (89%) and 42/48 (88%), respectively, (P = N.S.). Severe side-effects occurred in 11 (12%) of patients receiving bismuth based treatment compared to 1 (0.9%) patient receiving omeprazole based regimens (P < 0.02). Treatment failure in patients receiving omeprazole based treatment was associated with smoking (P < 0.05). Outside the context of clinical trials, both regimens achieved acceptable eradication rates. However, 1-week low-dose therapy is preferable due to the lower incidence of severe side-effects.