Twice daily (mid-day and evening) quadruple therapy for H-pylori infection in the United States

Background. Quadruple therapy provided inadequate eradication rate when given twice-a-day at breakfast and evening meals. Aim. To test twice daily (mid-day and evening) quadruple therapy for Helicobacter pylori eradication. Methods. This was a single-centre pilot study in which H. pylori-infected (positive histology and culture and RUT) patients were given 2 x 250 mg of metronidazole and 2 x 250 mg of tetracycline, two Pepto-Bismol tablets, plus one 20 mg rabeprazole tablet twice-a-day for 14 days. H. pylori status was confirmed 4 or more weeks after the end of therapy. Results. Thirty-seven patients including 3 with peptic ulcer disease, 19 asymptomatic infected, 4 GERD, and I I with NUD. Mid-day quadruple therapy was successful in 92.3% (95% Cl: 79-98%) including 96.2% of those with metronidazole-susceptible strains, and in 83.3% (10/12) of those with metronidazole-resistant H. pylori. Compliance was 100% by pill count except in one individual who stopped medication after 12 days because of side-effects and who failed therapy. Moderate or greater side-effects were experienced by five patients. Conclusion. Twice-a-day, mid-day, quadruple therapy proved effective using the combination of bismuth subsalicylate and rabeprazole instead of bismuth subcitrate and omeprazole. Detailed studies of different formulations (e.g. 2 x 250 mg versus I x 500 mg of metronidazole or tetracycline) and timing of administration (breakfast and evening meal versus mid-day and evening meals) may result in significant improvements in H. pylori eradication regimens. (C) 2004 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.