Efficacy of metronidazole-based triple therapy on eradicating HPylori positive peptic ulcers in mainly Saudi patients

ABSTRACT

To evaluate the short-term efficacy of triple antibiotics on eradicating H.pylori from peptic ulcer patients. Design: Prospective study. Peptic ulcer patients of both sexes were included if they were H. pylori positive on culture and/or histology and were aged between between 18-75 years. Patients were excluded if they had severe coagulopathy, if the females were pregnant and if antibiotics or non-sterioidal anti-inflammatory drugs had been recently used. All patients received a combination of metronidazole 500 mg PO t.i.d., amoxicillin 500 mg PO q.i.d., both for 2 weeks and bismuth subcitrate colloidal 120 mg PO q.i.d. for 4 weeks, in addition to ranitidine 300 mg PO at night for 6 weeks. Eradication of H.pylori was defined as absence of the organism in both histology and culture 6 weeks after completing triple therapy. H.pylori susceptibility was performed using the disc diffusion method. Forty-nine patients; 38 males, mean age 41.4 years and 11 females, mean age 40.3years were included. Eighty-four percent of peptic ulcers had healed by the end of the study period. However, only 49% of H.pylori was successfully eradicated. Overall metronidazole resistance was encountered in 45.7% of H.pylori isolate. Females harbored resistant strains more frequently than males, 77.8% versus 34.6%, respectively [p=0.03]. Metronidazole based triple therapy has a low success rate which is most likely secondary to H.pylori resistance