Eradication Rate of Helicobacter pylori using a Two-week Quadruple Therapy: A Report from Southern Iran

BACKGROUND: The use of quadruple therapy for Helicobacter pylori (H. pylori) eradication is a highly efficacious, gold standard regimen. However, according to a number of studies, this regimen has numerous compliance problems and adverse effects. In the current study we have evaluated the H. pylori eradication rate following a quadruple therapy that included omeprazole, bismuth subcitrate, amoxicillin, and metronidazole in Hormozgan, the most southern province in Iran. Hormozgan Province has high rates of H. pylori infection and its related disorders. METHODS: A total of 100 patients diagnosed with dyspepsia and H. pylori infection as documented by the (13)C-urea breath test (UBT) or rapid urease test (RUT) were treated with the following quadruple regimen: bismuth subcitrate (120 mg, 2 tablets/q12h), amoxicillin (500 mg/q8h), metronidazole (250 mg/q8h) and omeprazole (20 mg/q12h) for a two-week period. Our primary efficacy outcome was H. pylori eradication as established by a negative UBT at least four weeks after the end of treatment. RESULTS: Eradication rates were 79%.and 82.3%, respectively, based on the intention-to-treat and per-protocol analyses. Quadruple therapy had a similar effect in women (81%) and men (83.3%) for the eradication of H. pylori, which was not statistically significant. H. pylori eradication rates according to age groups were: 16-20 years (100%), 21-40 years (81%), and 41-60 years (77.8%; p=0.001). There was no significant difference in H. pylori eradication rate between genders in those less than 20 years of age and the middle age group. However in the older group the eradication rate was significantly higher in women (100%) compared to men (66.6%). CONCLUSION: A two-week quadruple therapy that includes omeprazole, bismuth subcitrate, amoxicillin and metronidazole is a highly effective treatment for H. pylori infection. This treatment has an acceptable eradication rate in Southern Iran. The eradication rate appears to be lower in older men compared with younger men or in women.