Triple therapy with azithromycin, omeprazole, and amoxicillin is highly effective in the eradication of Helicobacter pylori

A controlled trial versus omeprazole plus amoxicillin

G. Bertoni, R. Sassatelli, E. Nigrisoli, P. Tansini, G. Bianchi, G. Della Casa, A. Bagni, G. Bedogni

Research output: Contribution to journalArticle

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Abstract

Background: Azithromycin is a new-generation, acid-stable macrolide antibiotic that achieves remarkably high concentrations in gastric tissue, persisting above the MIC 90 for Helicobacter pylori over a 5-day period after a single 500-mg oral dose. Methods: We evaluated a new metronidazole- free triple therapy with omeprazole 20 mg b.i.d. plus amoxicillin 1 g b.i.d. (both for 14 days) and azithromycin 500 mg mane (for the first 3 days only) (group I) versus double therapy with omeprazole 20 mg b.i.d. plus amoxicillin 1 g t.i.d., both for 14 days (group II). H. pylori status was determined by urease test and histology before and 6 wk after completion of therapy. Results: Ninety-two patients with peptic ulcer disease or nonulcer dyspepsia completed the study. H. pylori infection was eradicated in 44 (91.6%) of 48 patients randomized to receive triple therapy versus 26 (59.1%) of 44 who received double therapy (p <0.001). Smoking, but not omeprazole pretreatment, proved to be a risk factor for treatment failure only in the double-therapy group (p = 0.05). All ulcers healed by the time of the 8-wk endoscopic control. Side effects, usually minor, were recorded in 12.5% and 9.1% of patients, respectively (NS), but therapy had to be discontinued in one patient in group I and in three in group II (NS). Conclusions: Two-week triple therapy with omeprazole, amoxicillin, and (for the first 3 days) low- dose azithromycin is highly effective in eradicating H. pylori. This regimen is safe and well-tolerated, and we recommend that it be used as first-line treatment, as an alternative to less-effective omeprazole-amoxicillin double therapy. Moreover, azithromycin appears to be a new, promising antibiotic for future innovative anti-H. pylori combinations.

Original languageEnglish
Pages (from-to)258-262
Number of pages5
JournalAmerican Journal of Gastroenterology
Volume91
Issue number2
Publication statusPublished - 1996

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Azithromycin
Omeprazole
Amoxicillin
Helicobacter pylori
Therapeutics
Anti-Bacterial Agents
Urease
Dyspepsia
Macrolides
Metronidazole
Helicobacter Infections
Group Psychotherapy
Treatment Failure
Peptic Ulcer
Ulcer
Stomach
Histology
Smoking
Acids

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Triple therapy with azithromycin, omeprazole, and amoxicillin is highly effective in the eradication of Helicobacter pylori : A controlled trial versus omeprazole plus amoxicillin. / Bertoni, G.; Sassatelli, R.; Nigrisoli, E.; Tansini, P.; Bianchi, G.; Della Casa, G.; Bagni, A.; Bedogni, G.

In: American Journal of Gastroenterology, Vol. 91, No. 2, 1996, p. 258-262.

Research output: Contribution to journalArticle

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abstract = "Background: Azithromycin is a new-generation, acid-stable macrolide antibiotic that achieves remarkably high concentrations in gastric tissue, persisting above the MIC 90 for Helicobacter pylori over a 5-day period after a single 500-mg oral dose. Methods: We evaluated a new metronidazole- free triple therapy with omeprazole 20 mg b.i.d. plus amoxicillin 1 g b.i.d. (both for 14 days) and azithromycin 500 mg mane (for the first 3 days only) (group I) versus double therapy with omeprazole 20 mg b.i.d. plus amoxicillin 1 g t.i.d., both for 14 days (group II). H. pylori status was determined by urease test and histology before and 6 wk after completion of therapy. Results: Ninety-two patients with peptic ulcer disease or nonulcer dyspepsia completed the study. H. pylori infection was eradicated in 44 (91.6{\%}) of 48 patients randomized to receive triple therapy versus 26 (59.1{\%}) of 44 who received double therapy (p <0.001). Smoking, but not omeprazole pretreatment, proved to be a risk factor for treatment failure only in the double-therapy group (p = 0.05). All ulcers healed by the time of the 8-wk endoscopic control. Side effects, usually minor, were recorded in 12.5{\%} and 9.1{\%} of patients, respectively (NS), but therapy had to be discontinued in one patient in group I and in three in group II (NS). Conclusions: Two-week triple therapy with omeprazole, amoxicillin, and (for the first 3 days) low- dose azithromycin is highly effective in eradicating H. pylori. This regimen is safe and well-tolerated, and we recommend that it be used as first-line treatment, as an alternative to less-effective omeprazole-amoxicillin double therapy. Moreover, azithromycin appears to be a new, promising antibiotic for future innovative anti-H. pylori combinations.",
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AU - Bertoni, G.

AU - Sassatelli, R.

AU - Nigrisoli, E.

AU - Tansini, P.

AU - Bianchi, G.

AU - Della Casa, G.

AU - Bagni, A.

AU - Bedogni, G.

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