Background: Cure rates of 7-day triple therapy seem to be decreasing. Quadr
uple therapies may be an alternative, although their complex administration
makes patient acceptance difficult.
Objective: To test the usefulness of a thrice a day, quadruple therapy to c
ure Helicobacter pylori infection.
Patients and methods: total of 122 consecutive patients with peptic ulcer a
nd Helicobacter pylori infection were treated with omeprazole 20 mg b.d., t
etracycline chlorhydrate 500 mg t.d.s., metronidazole 500 mg t.d.s., and bi
smuth subcitrate 120 mg t.d.s. administered with meals for 7 days. Cure was
tested by either endoscopy or breath test after 2 months, and by urea brea
th test 6 months after therapy.
Results: Seven patients were lost to follow-up. Of the remaining 115, 110 w
ere cured at the first control, giving an intention-to-treat cure rate of 9
0.2% (95% CI: 83-95%) and a per protocol cure rate of 95.7% (95% CI: 90-98%
). One hundred three patients returned for a 6-month breath test; all but o
ne were cured. Side-effects were minimal or minor in 47 patients (40.8%) an
d moderate in four (3.4%). Compliance was good, 95% of patients taking more
than 90% of the pills. Six (5%) patients stopped treatment after 1, 2, 4 (
two patients) and 6 (two patients) days.
Conclusion: Thrice a day quadruple therapy shows excellent cure rates, far
above 90%, is well-tolerated and compliance is easy. Head-to-head compariso
n with triple therapies as first line Helicobacter pylori treatment seems w