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Am Fam Physician. 2000;62(6):1375

Triple-drug therapy for Helicobacter pylori infection includes bismuth compound, metronidazole and tetracycline. The drawback of this complicated regimen is that it requires patients to take a large number of pills. In addition, the perception is that this regimen has more side effects than some of the other regimens. De Boer and colleagues conducted a pilot study of the efficacy and tolerability of a capsule that contains all three agents.

The study included 53 consecutive patients with H. pylori infection documented on at least two of three biopsy-based diagnostic tests. Thirty of the subjects had ulcer disease, and 23 had gastritis only. The monocapsule contained 60 mg of a colloidal bismuth subcitrate, 125 mg of tetracycline and 125 mg of metronidazole. Patients received two capsules four times daily for 10 days. The capsules were taken after meals and in the evening after a snack. Patients kept a symptom diary during the course of treatment. Endoscopic evaluation was repeated at least five weeks after completion of the treatment.

Treatment with the triple-drug capsule produced an overall cure rate of 94 percent (50 of 53 patients). Compliance was reported by 47 of the 52 patients for whom follow-up data were available. A questionnaire about side effects was completed by 49 of the 53 patients. Twelve (24.5 percent) reported no side effects, 23 (46.9 percent) reported mild side effects and 10 (20.4 percent) reported moderate side effects. Two (4 percent) had severe side effects. Only two patients stopped the regimen because of side effects.

The authors conclude that the monocapsule of bismuth, tetracycline and metronidazole is safe and effective for the treatment of H. pylori infection.

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