Background:Proton pump inhibitor-based triple therapy is recommended as tre
atment for Helicobacter pylori eradication. The proton pump inhibitor may b
e given once or twice daily. However, little information is available on ho
w these two treatment strategies compare.
Methods: H. pylori-positive patients (two positive test results) with endos
copy-proven healed duodenal ulcer or non-ulcer dyspesia were randomly alloc
ated to 1 week of double-blind treatment with pantoprazole 40 mg once or tw
ice daily, plus clarithromycin 250 mg and metronidazole 400 mg twice daily.
Eradication was defined as a negative C-13-urea breath test (C-13-UBT) and
histology, 4-5 weeks post-treatment. The follow-up phase comprised 12 mont
hs off therapy, with C-13-UBT at 6 and 12 months.
Results: Two hundred and four patients received treatment: pantoprazole onc
e daily (x1), n=104; twice daily (x2), n=100. Eradication rates were 84% in
both the pantoprazole x1 and pantoprazole x2 groups by modified intention-
to-treat analysis and 89% and 87%, respectively, by per protocol analysis.
Metronidazole resistance was found in 44% of pre-treatment cultures of H. p
ylori. Eradication rates were similar in susceptible (72%) and resistant (7
5%) strains. During follow-up, recrudescence of infection occurred in 3/118
Conclusion: When using pantoprazole plus clarithromycin and metronidazole,
the proton pump inhibitor can be used once daily without loss of efficacy.