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World J Gastroenterol. Jun 28, 2008; 14(24): 3855-3860
Published online Jun 28, 2008. doi: 10.3748/wjg.14.3855
Treatment of Helicobacter pylori in surgical practice: A randomised trial of triple versus quadruple therapy in a rural district general hospital
Siok Siong Ching, Sivakumaran Sabanathan, Lloyd R Jenkinson
Siok Siong Ching, Clinical Research Fellow in General Surgery, Leeds General Infirmary, Leeds, West Yorkshire LS1 3EX, England, United Kingdom
Sivakumaran Sabanathan, Lloyd R Jenkinson, Department of Surgery, Ysbyty Gwynedd, Bangor, Gwynedd LL57 2PW, Wales, United Kingdom
Author contributions: Ching SS contributed to the design and set up of the study, he also analysed and interpreted the data and wrote the draft manuscript; Sabanathan S contributed substantially to the recruitment of patients, acquisition of data for the study, and preparation of the manuscript; Jenkinson LR contributed substantially to the conception, administration support and overall supervision of the study, he also contributed substantially to the recruitment of patients and critically revised the manuscript.
Correspondence to: Lloyd R Jenkinson, Department of Surgery, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd LL57 2PW, Wales, United Kingdom. lloydjenk@btinternet.com
Telephone: +44-124-8384308
Fax: +44-124-8384675
Received: October 20, 2007
Revised: May 9, 2008
Accepted: May 16, 2008
Published online: June 28, 2008
Abstract

AIM: To compare a lansoprazole-based triple versus quadruple therapy for Helicobacter pylori (H pylori) eradication with emphasis on side effect profile, patient compliance and eradication rate at a rural district general hospital in Wales, United Kingdom.

METHODS: One hundred one patients with H pylori infection were included in the study. Patients were randomised to receive triple therapy comprising of lansoprazole 30 mg, amoxycillin 1 g, clarithromycin 500 mg, all b.d. (LAC), or quadruple therapy comprising of lansoprazole 30 mg b.d., metronidazole 500 mg t.d.s., bismuth subcitrate 240 mg b.d., and tetracycline chloride 500 mg q.d.s. (LMBT). Cure was defined as a negative 13C urea breath test 2 mo after treatment.

RESULTS: Seven patients were withdrawn after randomisation. Fifty patients were assigned to LAC group and 44 to LMBT group. The intention-to-treat cure rates were 92% and 91%, whereas the per-protocol cure rates were 92% and 97%, respectively. Side effects were common, with 56% experiencing moderate to severe symptoms in the LAC group and 59% in the LMBT group. Symptoms of vomiting, diarrhoea and black stools were significantly more common in the LMBT group. Patient compliance was 100% for triple therapy and 86% for quadruple therapy (P < 0.01). One-third of patients in both groups were still taking acid-reducing medications at six-month follow-up.

CONCLUSION: One-week triple and quadruple therapies have similar intention-to-treat eradication rates. Certain side effects are more common with quadruple therapy, which can compromise patient compliance. Patient education or modifications to the regimen are alternative options to improve compliance of the quadruple regimen.

Keywords: Helicobacter pylori; Triple therapy; Quadruple therapy; Side effects; Treatment compliance; Eradication rate