Correspondence

Treatment of Helicobacter pylori Infection in Peptic Ulcer Disease

N Engl J Med 1996; 334:474February 15, 1996

Article

To the Editor:

I applaud Drs. Walsh and Peterson (Oct. 12 issue)1 for their review of treatment regimens for the eradication of Helicobacter pylori. In Table 1 of their article, several treatment regimens are presented with accompanying data on efficacy and side effects. All the regimens listed consist of three drugs given for at least 10 days; the cited rates of eradication of H. pylori ranged from 84 to 90 percent.

In 1994 Marshall2 reported a cure rate of 90 percent with a regimen of metronidazole at a dose of 250 mg four times daily, omeprazole at a dose of 20 mg twice daily, and clarithromycin at a dose of 500 mg twice daily; all were given for only seven days. These results indicate that H. pylori can be eradicated by short-term therapy.

Jason C. Sniffen
Nova Southeastern University of the Health Sciences, Fort Lauderdale, FL 33314

2 References

1. 1

   Walsh JH, Peterson WL. The treatment of Helicobacter pylori infection in the management of peptic ulcer disease. N Engl J Med 1995;333:984-991
   Full Text | Web of Science | Medline

2. 2

   Marshall BJ. Helicobacter pylori. Am J Gastroenterol 1994;89:Suppl:S116-S128
   Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: The field of H. pylori therapy is evolving rapidly. As Sniffen points out, regimens of two antimicrobial drugs (clarithromycin and metronidazole or amoxicillin) plus a proton-pump–inhibitor drug such as omeprazole given for seven days will eradicate H. pylori in over 90 percent of patients with peptic ulcer disease.1 We noted in our article that the addition of omeprazole to a regimen of three antibiotics (bismuth, metronidazole, and tetracycline) given for seven days eradicated H. pylori in over 90 percent of patients.2 Thus, substantial progress is being made toward the goal of shorter, more convenient regimens to treat this infection.

John H. Walsh, M.D.
Walter L. Peterson, M.D.
UCLA School of Medicine, Los Angeles, CA 90073

2 References

1. 1

   Goddard A, Logan R. One-week low-dose triple therapy: new standards for Helicobacter pylori treatment. Eur J Gastroenterol Hepatol 1995;7:1-3
   Web of Science | Medline

2. 2

   de Boer W, Driessen W, Jansz A, Tytgat G. Effect of acid suppression on efficacy of treatment for Helicobacter pylori infection. Lancet 1995;345:817-820
   CrossRef | Web of Science | Medline