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Increasing antibiotic resistance has resulted in decreased eradication rates from standard triple therapy for Helicobacter pylori infection.
Investigators in 16 Spanish hospitals compared the efficacy of triple therapy with esomeprazole (40 mg), amoxicillin (1 g), and clarithromycin (500 mg) twice daily for 14 days and quadruple therapy with the same regimen plus metronidazole (500 mg twice daily). The first 402 consecutively enrolled patients received triple therapy, and the next 375 patients received quadruple therapy. Eradication was confirmed by a urea breath test performed ≥1 month post-therapy.
In intention-to-treat analysis, H. pylori eradication was higher with quadruple versus triple therapy (90.4% vs. 81.3%; P<0.001). Mild or modera…