Adjuvant therapy for Helicobacter pylori eradication: role of lansoprazole in clinical studies

Abstract

Helicobacter pylori (Hp) eradication can lead to cure of duodenal ulcer. Eradication of Hp was first attempted with bismuth salts alone or in combination with one or two antibiotics. In 1990, triple therapy with bismuth, tetracycline or amoxicillin, and metronidazole or tinidazole was standard. Proton pump inhibitors are active in vitro against Hp and have therefore been tested in monotherapy, dual therapy, and triple therapy. When lansoprazole was used as monotherapy, the mean Hp eradication was 6% in four studies. When lansoprazole was used in dual therapy with amoxicillin, pooled data from four trials employing various dosage schedules showed Hp eradication in 38.9% of patients. When lansoprazole was used in dual therapy with clarithromycin, the eradication rate was about 47.7% with lansoprazole 30 mg daily and 69.1% with lansoprazole 30 mg twice daily. When lansoprazole was used in triple therapy, Hp eradication rates ranged from 80% to 96%, with the best results obtained with a combination of lansoprazole, amoxicillin, and clarithromycin. Lansoprazole together with one or preferably two antibiotics is effective in Hp eradication. With the new macrolides, which have a lower rate of Hp resistance than metronidazole or tinidazole, we can expect to achieve eradication of Hp in all patients who are compliant with antibiotic therapy and infected with sensitive strains.