مقايسه رژيم سه دارويي 7 و 14 روزه حاوي كلاريترومايسين ، آموكسي سيلين و امپرازول در درمان هليكوباكتر پيلوري

COMPARISON OF 7 DAYS VERSUS 14 DAYS TREATMENT WITH CLARITHROMYCIN, AMOXICILIN AND OMEPRAZOLE FOR ERADICATION OF HELICOBACTER PYLORI

Background&Aim: Helicobacter pylori (H. P) infection is one of the most common infections in the worldwide. It has been accepted as a major cause of peptic ulcer disease. Eradication of Helicobacter pylori infection leads to cure of ulcers, reduction of its complications, and prevents relapse. In various regimens in the world, triple therapeutic regimens with metronidazol or claritromycin bases as 7 , 10 and 14 days courses, has been suggested. These regimens usually contains a proton pump inhibitor and another antibiotic. Clarothromycin , was shown to be a good alternative to metronidazole in therapy for helicobacter pylori eradication especially in areas where metronidazole resistant bacteria are common. A randomized controlled clinical trial to determine the efficacy of triple therapy with clarithromycin , amoxicillin and omeperazole for eradication of H.P.was done and comparision of 7 days versus 14 days treatment with such regimens. Materials &Methods: This study carried out on patients who had peptic ulcer or dyspepsia that was established by endoscopy and endoscopic biopsy samples of them were positive for rapid urease test and histopathological studies . The patients were divided randomly in two groups . Group A was treated with clarithromycin 500 mg b.i.d. , amoxicilin 1 gr b.i.d. and omeprazole 20 mg b.i.d. for 7 days and group B was treated with such drugs and regimens for 14 days. Clinical evaluation and reendoscopy were carried out 4 weeks after finishing treatment and if both of rapid urease test and histopatological studies on biopsy samples were negative , H.P. eradication was accepted . Results: 65 of 81 patients enrolled into this study completed the study and returned for repeated endoscopy. The per protocol H.P. eradication rates in group A (35 patients ) and group B ( 30 patients ) were 85.6% and 86.6% , respectively ( p=0.6). Although the intent - to - treat eradication rates decreased, that for group A (N = 41) and group B (N = 40) were 73.1% and 65% respectively (p =0.42 ) There is not any significant relationship between the H.P. eradication rates and age, sex, severity of inflammation on pathological samples and presence of peptic ulcer or dyspepsia. 19.5% of patients had minor side effects but there was not shown any major side effect and significant relationship between side effects and the duration of therapy. Discussion: Triple therapy containing clarithromycin results in an acceptable eradication rates of H.P. infection and there isnʹt any significant difference between the two above protocols.