Background: Triple therapy with proton pump inhibitor, clarithromycin and a
moxicillin has recently been proposed in Maastricht as first-line treatment
for H. pylori infection.
Aim: To determine predictors of unsuccessful eradication.
Methods: Two hundred and forty-eight patients underwent endoscopy with biop
sies for rapid urease test, histology and culture with antibiotic susceptib
ility tests, and C-13-UBT. All infected patients were given pantoprazole (4
0 mg b.d.), clarithromycin (500 mg b.d.) and amoxicillin (1 g b.d.) for 1 w
eek. Eradication was assessed by UBT at 4-6 weeks after therapy.
Results: One hundred and sixty-two of 248 patients (65%) were infected. Cul
ture was positive in 144 (89%), Prevalence rates of metronidazole, clarithr
omycin and amoxicillin resistance were 14, 8 and 3%, respectively. Eradicat
ion rates (95% CI) were 63% (54.7-70.6) by intention-to-treat analysis and
67% (59.4-75.4) by per protocol analysis. Drug compliance was excellent and
side-effects were mild. Age greater than or equal to 45 years (OR: 2.35, C
I: 1.30-4.25), smoking (OR: 1.37, CI 1.01-1.87) and high pre-treatment UBT
results (OR: 1.36, CI: 1.08-1.72) were independent predictors of eradicatio
n failure. Gender, endoscopic findings, alcohol intake, and clarithromycin
and amoxicillin resistance did not predict treatment failure.
Conclusion: Despite the low prevalence of primary antibiotic resistance in
our geographical area, triple therapy with pantoprazole, amoxicillin and cl
arithromycin achieves low eradication rates. Smoking, age and pre-treatment
UBT results are predictors of potential eradication failure.