Research Article| Volume 21, ISSUE 9, P1539-1548, September 1999

Efficacy of omeprazole plus two antimicrobials for the eradication of Helicobacter pylori in a Turkish population

      This paper is only available as a PDF. To read, Please Download here.


      Omeprazole combined with 2 antimicrobials has been suggested as a first-line option for Helicobacter pylori eradication in recent years. However, controversy exists regarding the efficacy of this protocol. This open-label, prospective clinical study investigated the efficacy of omeprazolebased triple therapy for H pylori eradication in 518 patients with H pylori-positive functional dyspepsia with or without duodenal ulcer. Amoxicillin, macrolides (clarithromycin or roxithromycin), and nitroimidazoles (metronidazole, ornidazole, or tintdazole) were the antibiotics used in the study. Nonulcer patients were randomly assigned to 1 of 8 different treatment protocols anu duodenal ulcer patients were randomly assigned to 1 of 4 different treatment protocols consisting of omeprazole (20 mg once daily for nonulcer patients, 20 mg twice daily for ulcer patients for 14 days) with a combination of 2 of the above antimicrobials (for 10 days). H pylori infection was assessed by histologic findings and a rapid urease test before therapy and 4 weeks after therapy ended. Four hundred fifty-nine patients completed their regimens; 327 had functional dyspepsia (180 men, 147 women; median age, 39 years; range, 18 to 70 years) and 132 had ulcers (81 men, 51 women; median age, 40 years; range, 18 to 70 years). Eradication of H pylori was achieved in 58.8% (270 of 459) of all patients, 58.1% (190 of 327) of nonulcer dyspeptic patients, and 60.6% (80 of 132) of duodenal ulcer patients. The eradication rate varied from 47.2% to 69.4% in different treatment protocols. There were no statistically significant differences in eradication rates in any treatment group. All drugs were generally well tolerated in all groups, and no patient discontinued treatment because of side effects. Therapy witn omeprazole and 2 antimicrobials for H pylori had limited efficacy in a Turkish population. The reason for these results, which conflict with those of other studies, is not clear. Further investigations of regimens for the eradication of H pylori in our population are necessary.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • National Institutes of Health Consensus Conference
        Helicobacter pylori in peptic ulcer disease. NIH Consensus Development Panel on Helicobacter pylori in Peptic Ulcer Disease.
        JAMA. 1994; 272: 65-69
        • Graham DY
        Treatment of peptic ulcers caused by Helicobacter pylori.
        N Engl J Med. 1993; 328: 349-350
        • Kadayifci A
        • Simsek H
        Do Helicobacter pylori-positive duodenal ulcers have an increased risk of bleeding?.
        Am J Gastroenterol. 1995; 90 (Letter): 1901
        • Labenz J
        • Börsch G
        Role of Helicobacter pylori eradication in the prevention of peptic ulcer bleeding relapse.
        Digestion. 1994; 55: 19-23
        • Glupezynski Y
        • Burette A
        Drug therapy for Helicobacter pylori infection: Problems and pitfalls.
        Am J Gastroenterol. 1990; 85: 1545-1551
        • Chiba N
        • Rao BV
        • Rademaker JW
        • Hunt RH
        Meta-analysis of the efficacy of antibiotic therapy in eradicating Helicobacter pylori.
        Am J Gastroenterol. 1992; 87: 1716-1727
        • Graham DY
        • Lew GM
        • Malaty HM
        • et al.
        Factors influencing the eradication of Helicobacter pylori with triple therapy.
        Gastroenterology. 1992; 102: 493-496
        • Labenz J
        • Ruhl GH
        • Bertrams J
        • et al.
        Medium-or high-dose omeprazole plus amoxicillin eradicates Helicobacter pylori in gastric ulcer disease.
        Am J Gastroenterol. 1994; 89: 726-730
        • Simsek H
        • Kadayifci A
        • Tatar G
        Low eradication rates of Helicobacter pylori with omeprazole plus amoxycillin combination in a Turkish population.
        Am J Gastroenterol. 1996; 91 (Letter): 1062
        • van der Hulst RWM
        • Keller JJ
        • Rauws EAJ
        • Tytgat GNJ
        Treatment of Helicobacter pylori infection: A review of the world liter-ature.
        Helicobacter. 1996; 1: 6-19
        • Buckley MJM
        • Deltenre M
        Treatment of Helicobacter pylori infection.
        Curr Opin Gastroenterol. 1997; 13: 56-62
        • Labenz J
        • Stolte M
        • Peitz U
        • et al.
        Oneweek triple therapy with omeprazole, amoxycillin and either clarithromycin or metronidazole for cure of Helicobacter pylori infection.
        Aliment Pharmacol Ther. 1996; 10: 207-210
        • Goddard A
        • Logan R.
        One-week low-dose triple therapy: New standards for Helicobacter pylori treatment..
        Eur J Gastroenterol Hepatol. 1995; 7: 1-3.
        • Lind T
        • Veldhuyzen van Zanten SJO
        • Unge P
        • et al.
        Eradication of Helicobacter pylori using one-week triple therapies combining omeprazole with two antimicrobials. The MACH l Study.
        Helicobacter. 1996; 1: 138-144
        • Hui WM
        • Lam SK
        • Ho J
        • et al.
        Effect of omeprazole on duodenal ulcer-associated antral gastritis and Helicobacter pylori.
        Dig Dis Sci. 1991; 36: 577-582
        • Walsh JH
        • Peterson WL
        The treatment of Helicobacter pylori infection in the management of peptic ulcer disease.
        N Engl J Med. 1995; 333: 984-991
        • Hardy DJ
        • Hanson CW
        • Hensey DM
        • et al.
        Susceptibility of Campylobacter pylori to macrolides and fluoroquinolones.
        J Antimicrob Chemother. 1988; 22: 631-636
        • Logan RPH
        • Bardhan KD
        • Celestin LR
        • et al.
        Eradication of Helicobacter pylori and prevention of recurrence of duodenal ulcer: A randomized, double-blind, multicentre trial of omeprazole with or without clarithromycin.
        Aliment Pharmacol Ther. 1995; 9: 417-423
        • Guay DR
        • Patterson DR
        • Seipman N
        • Craft JC
        Overview of the tolerability profile of clarithromycin in preclinical and clinical trials.
        Drug Saf. 1993; 8: 350-354
        • Peterson WL
        • Graham DY
        • Marshall B
        • et al.
        Clarithromycin as monotherapy for eradication of Helicobacter pylori: A randomized double-blind trial.
        Am J Gas-troenterol. 1993; 88: 1860-1864
      1. (Abstract)
        • Simsek H
        • Kadayifci A
        • Tatar G
        Short course of roxithromycin, nitroimidazine and omeprazole therapy for the eradication of Helicobacter pylori.
        in: Presented at the Digestive Disease Week and the 96th Annual Meeting of the American Gas- troenterological Association, May 19–22, 1996; San Francisco, CaliforniaGastroenterology. 110. 1996: A259
        • Malizia T
        • Tejada M
        • Marchetti F
        • et al.
        Synergic interactions of macrolides and protonpump inhibitors against Helicobacter pylori: A comparative in-vitro study.
        J Antimicrob Chemother. 1998; 41: 29-35
        • Pavicic MJAM
        • Namavar F
        • Verboom T
        • et al.
        In vitro susceptibility of Helicobacter pylori to several antimicrobial combinations.
        Antimicrob Agents Chemother. 1993; 37: 1184-1186
        • Pounder RE
        • Williams MP
        The treatment of Helicobacter pylori infection.
        Aliment Pharmacol Ther. 1997; 11: 35-41
        • Noach LA
        • Langenberg WL
        • Bertola MA
        • et al.
        Impact of metronidazole resistance on the eradication of Helicobacter pylori.
        Scand J Infect Dis. 1994; 26: 321-327
        • Megraud F
        Resistance of Helicobacter pylori to antibiotics.
        Aliment Pharmacol Ther. 1997; 11: 45-53
        • Malfertheiner P
        • Megraud F
        • O'Morain C
        • et al.
        Current European concepts in the management of Helicobacter pylori infection—the Maastricht Consensus Report. The European Helicobacter pylori Study Group (EHPSG).
        Eur J Gastroenterol Hepatol. 1997; 9: 1-2
        • Buke C
        • Aydin A
        • Gunsar F
        • et al.
        The susceptibility of Helicobacter pylori to vari-ous antibiotics.
        Turk J Gastroenterol. 1996; 7 (Abstract. In Turkish): B55