RESULTS OF PPI-BASED TRIPLE THERAPIES OR PPI-BASED QUADRUPLE THERAPIES FOR CURE OF H. PYLORI INFECTION IN HALIFAX

C Nash, L Best, D Haldane, D Malatjalian, S Veldhuyzen van Zanten

Department of Medicine, Dalhousie University, Halifax, Nova Scotia

To determine the prevalence of metronidazole resistance and success of PPI-based triple and quadruple therapies in a single GI centre in Nova Scotia.
A non-consecutive series of 156 patients treated for H. pylori infection. Helicobacter pylori status was determined by histology and culture of endoscopically-obtained biopsies and in a small number of patients by serology (pre-treatment only)or Urea Breath Test. Metronidazole resistance was determined by disk diffusion tests (>8 mcg/ml).
In patients who had not received previous anti-Helicobacter therapy 61 of 81 (75%) patients treated with PPI-clarithromycin-amoxicillin for 7 days achieved cure of H. pylori infection. For PPI-CM the rate was 27/43 (63%) in those patients in whom cultures were available. For PPI-CM the success rate in metronidazole sensitive strains was 12 of 16, 75% for PPI resistant strains 6/11 (55%). The success rates for patients treated for a second or third time was 4/9 (44%) for PPI’s CA and 3/9 (33%) for PPI-CM. For PPI-BMT quadruple therapy, which was second line treatment only the cure rate was 9/14 (64%)
Results of PPI-based triple therapy are not as good as reported in clinical trials. For second line therapy, PPI-based quadruple therapy with bismuth appears to be better than repeat treatment with triple therapy, but a randomized trial is required to prove this.

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