INCREASING ANTIBIOTIC RESISTANCE IS THE MAIN CAUSE FOR THE FAILURE OF HELICOBACTER PYLORI ERADICATION: COMPARISON OF THREE TRUSTED TREATMENT PROTOCOLS

Introduction: Because of the decrease in the success of standard triple treatment in Helicobacter pylori (HP) eradication, new treatment modalities has been developed. But it is not known which of them is the most suitable regimen. We aimed to compare eradication rates of different eradication protocols. Materials and methods: 273 patients with dyspeptic complaints and naive Helicobacter pylori infection were randomized into three groups: 71 patients received quadruple therapy (QT) (proton pump inhibitor bid, bismuth salts 2x2, metronidazole 500 mg tid and tetracycline 500 mg qid, applied simultaneously for 14 days), 127 patients received concomitant therapy (CT) (proton pump inhibitor bid, amoxicillin 1000 mg bid, clarithromycin 500 mg bid and metronidazole 500 mg tid applied for 10 day) or 75 patients received levofloxacin containing sequential therapy (LST) (amoxicillin 1000 mg bid and proton pump inhibitor bid for first 5 days, following this proton pump inhibitor bid, levofloxacin 500 mg/day, metronidazole tid for remaining 5 days). Results: There were no significant differences in eradication rates between three treatment groups in the intention to treat analysis [QT: 64,8% (53,6-76,0%); CT: 77,2% (70,0-84,4%); LST: 70,7% (65,4-81,1%), P >0.05] and per protocol analysis [QT: 66,7% (55,7%-77,9%) CT: 77,8% (70,5-85,1%), LST: 72,6%,(62,4-82,8%), P >0.05]. Conclusion: None of these three regimens were suitable for the consistent achievement of grade A results. It is still a challenge to define how eradication protocols can be improved in regions with high antibiotic resistance.