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Am Fam Physician. 1999;60(6):1801

Treatment of peptic ulcer disease is now often accomplished with regimens aimed at eradicating bacteria. Bismuth plus two antibiotics for 14 days is one standard treatment, but this regimen is associated with poor compliance and failure to eradicate the bacteria. Moshkowitz and colleagues conducted this prospective study to determine if combining omeprazole, nitroimidazole and clarithromycin in a short-course treatment was effective and tolerated in older patients with peptic ulcer disease related to Helicobacter pylori. Patients were included if they were at least 61 years of age and had dyspeptic symptoms plus a positive H. pylori test. All patients were treated for one week with 20 mg of omeprazole, 250 mg of clarithromycin and 500 mg of tinidazole, all twice daily. One group was made up of those who had not successfully achieved H. pylori eradication after a course of metronidazole and bismuth (group 2), and the other group included those who had not previously been treated (group 1). All patients were tested with a urea breath test for eradication of H. pylori four weeks after finishing the treatment. Any therapy with proton pump inhibitors or H2 blockers was stopped one week before the urea breath test.

The study consisted of 71 men and 63 women. Gastritis was the diagnosis in 46, duodenitis in 28, gastric ulcer in eight and duodenal ulcer in 52. Most of the subjects (83.6 percent) received their first treatment for H. pylori–associated dyspepsia during this study. Almost all of the group 1 patients (92.8 percent) had H. pylori eradication at the end of the study. Only 68.2 percent of the group 2 patients had successful eradication. There were no major adverse effects in any of the patients.

The authors conclude that one week of triple therapy with omeprazole, clarithromycin and tinidazole was effective in eradicating H. pylori in older patients who had not previously been treated. The success of this regimen is decreased in patients who have previously had a treatment failure.

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