High-Dose PPI, Amoxicillin, and Metronidazole for Primary Treatment of H. pylori Infection?

The standard treatment for Helicobacter pylori infection — triple therapy with a proton-pump inhibitor (PPI), clarithromycin, and either amoxicillin or metronidazole — is becoming less effective because of increasing clarithromycin resistance. Recommended alternative therapies have a variety of drawbacks. Investigators in Spain have suggested that the low eradication rates seen in earlier studies of metronidazole and amoxicillin could be explained by suboptimal dosing schedules, and that an appropriately dosed regimen might be successful in settings where clarithromycin resistance rates are high.

In a multicenter study involving 136 patients with documented H. pylori infection, these researchers used a strategy devised to sidestep clarithrom…