Triple therapy as a cure for Helicobacter pylori infection

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Abstract
Helicobacter pylori is widely accepted as the cause of type B gastritis, with a critical role in gastric and duodenal ulceration. Eradication of H.pylori has therefore become a primary goal for physicians treating these conditions. This article reviews the development for combination therapies designed to eradicate H.pylori and cure ulcers. Early combination therapies comprised bismuth plus two antibiotics. This regimen achieved eradication rates of approximately 86%, but was associated with a relatively high incidence of adverse effects. The search for simpler, better tolerated regimens led to the development of proton-pump inhibitor dual therapy, typically combining a proton-pump inhibitor with amoxycillin. Reported treatment outcomes with this regimen vary widely, and relatively high doses of proton-pump inhibitor are required to achieve eradication rates greater than 80%. Proton-pump inhibitor triple therapy is now believed to be the most effective way of eradicating H.pylori and healing ulcers. Preliminary data have suggested that pantoprazole is effective when used in this way, with eradication rates of about 90%. These early indications have been confirmed by the results of a recently completed clinical trial, in which patients were treated with pantoprazole at 40 mg twice a day plus clarithromycin at 250 mg twice a day plus tinidazole at 500 mg twice a day for 10 days. The overall eradication rate was 86%, and the treatment was well tolerated. Short-term triple therapy using a proton-pump inhibitor such as pantoprazole is effective, well tolerated and suitable for wider use in the treatment of gastric and duodenal ulcers.

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