Omeprazole once or twice daily with clarithromycin and metronidazole
In 1993, Bazzoli introduced the highly effective Helicobacter pylori eradication regimen of omeprazole 20 mg once daily, clarithromycin 250 mg bid and tinidazole 500 mg bid for one week. However, tinidazole is not available in Canada. Since that time, many other studies using a proton pump inhibitor (PPI) in combination with clarithromycin and another nitroimidazole, metronidazole, have been reported with consistent efficacy. The first of these was the landmark MACH 1 study, which used omeprazole 20 mg bid with clarithromycin 250 mg bid and metronidazole 400 mg bid for one week to achieve 94.3% eradication. Subgroup analysis of the Canadian patients in this study demonstrated that results were the same as for the European patients. In Canada, the 400 mg dose of metronidazole is not available; however, the 500 mg dose is as effective. Other PPIs such as lansoprazole and pantoprazole have similar efficacy.
Due to its efficacy, European and Canadian H pylori consensus conferences have recommended that triple therapy with a PPI, clarithromycin and metronidazole be one of the first line therapies for H pylori eradication. The Maastricht Consensus Report considered tinidazole and metronidazole to be interchangeable.
The omeprazole once daily dose has been used extensively in combination with clarithromycin and tinidazole, in contrast to studies using metronidazole where omeprazole was mostly given twice daily. It is unclear and unknown whether omeprazole needs to be given once or twice daily when used in combination with clarithromycin and metronidazole. Furthermore, in today’s financial climate, a lower dose of omeprazole would help contain costs.
Thus, in this study, clarithromycin 250 mg bid was used with metronidazole 500 mg bid, combined with omeprazole 20 mg either once or twice daily for one week to assess their efficacies in eradicating H pylori in a single, Canadian, community-based gastroenterology practice.
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