Azithromycin, furazolidone and omeprazole: a promising low-dose, short-term, anti-H. pylori triple therapy

Aim: Tocompare four anti-H. pylori regimes using omeprazole and azithromycin associated to different antimicrobials in peptic ulcer H. pylori positive patients. Patients and methodos: afterinformed consent, 136 endoscopically proven peptic ulcer patients(74 male, 62 female) were randomly assigned to one of thefollowing therapy groups: Group 1: Om 20mg mane for 7 ays + Az 500mgmane for 3 days + tinidazole (Ti) 500mg bid for 7 ays. Group 2: Om 20 mg mane for 7 days + Az 500mane for 3 days + amoxycilin (Am) 500mg tid for 7 days. Group 3 Om 20 mg mane for 7 days + Az 500mg mane for 3 days + furazolidone (F) 200 mg tid for 7 days. Group 4: Om 20 mg mane for 7 days +Az 500mg mane for 3 days + colloidal bismuth subcitrate (CBS) 120 mg tid ( double dose at bedtime) for7 days. The H. Pylori status was assessed before treatment and 94 (63-214) days post treatment using urease test, and 14C-urea breath test. Statistical analysis was performed by Kruskal-Wallis test, chi-square test, Fisher's exact test, and Lancaster & Irvin method. Results: The four groups had similar demographic and clinical characteristics. 120/136 patients completed the study. One patient discontinued treatment due to side effects and 15 were lost to follow-up.32/136 (23.5por cento) hed side effect during treatment, mainly nause. H.pylori eradication in group 3 was statistically different from the other groups ( p=0.000). Group 3 & 4 (statistically non-different) presented significantly more side effects than group 1 and 2 (p=0.002). Conclusion: 1)Om + Associated to F (the cheapest ant- H.Pylori drug) for one week represents an efficient reasonaaable well-tolerates alternatiaaaaaave to H.pylori eradication. 2) Future studies testing F with other macrolides or Az during 7 days can enhance H. Pylori eradication rates

One-week triple therapy with omeprazole plus azithromycin and secnidazole is ineffective in eradicating "helicobacter pylori"

Background: There is not yet consensus on the most effective treatment for the helicobacter pylori infection, particularly in most developing countries. Azithromycin is a new macrolide and relatively novel agent for H. pylori eradication with an in vitro MIC90 lower than 1 mg/ml.Secnidazole, a nitromidazole that causes fewer side effects than metronidazole, was recenty reported to be used, for the firt time, in the treatment of H. pylori infection. Aim: To evaluate, in a prospective, randomized, single-center study, the association of twodifferent doses of omeprazole, azithromycin and secnidazole in H. pylori eradication. Patients and methods: After informed consent, 55 patients (36m,19F) with duodenal ulcer associated with H. pylori infection were randomized to receive omeprazole 20mg uid (Group A) or 20mg bid (Group B) for sevem days plus azithromycin 500mg uid for six days and secnidazole 2,000mg uid in the first, fourth and seventh day. The H. pylori status was assessed before and 60-90 days posttreatment using urease test, histology and 13C-urea breath test. Statistical analysis was performed by X² test. Results: The two groups had similar demographic characteristics. Fifty-five patients (36M, 19F) were enrolled. Six patients did not show-up for the second visit posttreatment. So, of the 49 evaluable patients, 25por cento (6/24) in Group A and 44por cento(11/25) in Group B wereeradicated, in a per protocol (PP) analysis. Intetion-to-treat (ITT) eradication rates were 21,4por cento (6/28) in Group A and 40.7por cento (11/27) im Group B. The differences betweem ITT and PP analysis from the two groups were not statistically significant. Conclusions: This study shows a very low eradication rate with the two regimens comprising of omeprazole, azithromycin and secnidazole and therefore, should not be recommended for thetreatment of H. pylori infection

Application of isotope-selective non-dispersive infrared spectrometry for the evaluation of the 13C-urea breath test: comparison with three concordant methods

The aim of this work was to compare the performance of isotope-selective non-dispersive infrared spectrometry (IRIS) for the 13C-urea breath test with the combination of the 14C-urea breath test (14C-UBT), urease test and histologic examination for the diagnosis of H. pylori (HP) infection. Fifty-three duodenal ulcer patients were studied. All patients were submitted to gastroscopy to detect HP by the urease test, histologic examination and 14C-UBT. To be included in the study the results of the 3 tests had to be concordant. Within one month after admission to the study the patients were submitted to IRIS with breath samples collected before and 30 min after the ingestion of 75 mg 13C-urea dissolved in 200 ml of orange juice. The samples were mailed and analyzed 11.5 (4-21) days after collection. Data were analyzed statistically by the chi-square and Mann-Whitney test and by the Spearman correlation coefficient. Twenty-six patients were HP positive and 27 negative. There was 100 per cent agreement between the IRIS results and the HP status determined by the other three methods. Using a cutoff value of delta-over-baseline (DOB) above 4.0 the IRIS showed a mean value of 19.38 (minimum = 4.2, maximum = 41.3, SD = 10.9) for HP-positive patients and a mean value of 0.88 (minimum = 0.10, maximum = 2.5, SD = 0.71) for negative patients. Using a cutoff value corresponding to 0.800 per cent CO2/weight (kg), the 14C-UBT showed a mean value of 2.78 (minimum = 0.89, maximum = 5.22, SD = 1.18) in HP-positive patients. HP-negative patients showed a mean value of 0.37 (minimum = 0.13, maximum = 0.77, SD = 0.17). IRIS is a low-cost, easy to manage, highly sensitive and specific test for H. pylori detection. Storing and mailing the samples did not interfere with the performance of the test.

Antiácido de alta potência versus cimetidina no tratamento da úlcera duodenal: comodidade posológica / High potency antacid versus cometidine in the treatment of duodenal ulcer: commodus psosology

Foram estudados 98 pacientes com úlcera péptica duodenal distribuídos de forma randômica em dois grupos. Um grupo recebeu antiácido liquido de alta potência (282,4mEq/dia) dividido em 4 tomadas durante 4 semanas e outro recebeu cimetidina (800 mg/dia) dividida em 2 tomadas por igual período. A potência antiácida da associaçäo líquida utilizada é de 7,06 mEq/ml. Todos os pacientes foram avaliados clinicamente no pré-tratamento e duas e quatro semanas após, com exames endoscópicos realizados na admissäo e após quatro semanas. A eficácia, considerada como cicatrizaçäo da úlcera duodenal associada a melhora da sintomatologia foi equivalente para ambos os tratamentos, näo havendo diferença estatisticamente significante. A tolerabilidade de ambas as drogas foi considerada boa