Abstract

Despite reports on high prevalence of Helicobacter pylori (H. pylori) infection especially in developing countries, considerable low H. pylori eradication rate has been shown following different triple therapies. The present study has for the first time assessed and compared the efficacy of the two 14day PPI-based triple therapies with and without a fluoroquinolone among an Iranian population. Two hundred and seventy patients with peptic ulcer and positive H. pylori infection were included in the study. Patients were randomly assigned to one of the two treatment protocols. A 14day triple therapy comprising omeprazole 20 mg, amoxicillin 1 g and ofloxacin 400 mg (OAO group) and a 14 day triple regimen comprising omeprazole 20 mg plus amoxicillin 1 g and clarithromycin 500 mg (OAC group) all given twice daily. Cure was defined as a negative urea breath test at least four weeks after the end of treatment. Among 135 patients in each group, 129 patients in OAO group (95.6%) and 100 patients in OAC group (74.1%) could continue treatment protocols and underwent ¹³C-urea breath testing while other ones discontinued because of any intolerable adverse events. The per-protocol eradication rates achieved with OAC regimen was significantly higher than the OAO treatment protocol (89.0 vs 73.6%). Two-week PPI-based triple therapy including amoxicillin and clarithromycin is already an effective regimen for H. Pylori eradication while triple therapy comprising ofloxacin is not a recommendable schedule because of high increasing resistance to fluoroquinolones among the Iranian population.

Key words: Helicobacter pylori, therapy, resistance, antibiotic.