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A randomized comparison of quadruple and triple therapies for helicobacter pylori eradication: The QUADRATE study.

Katelaris, Peter H., Forbes, Geoffrey M., Talley, Nicolas J. and Crotty, Brendan 2002, A randomized comparison of quadruple and triple therapies for helicobacter pylori eradication: The QUADRATE study., Gastroenterology, vol. 123, no. 6, pp. 1763-1769, doi: 10.1053/gast.2002.37051.

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Title A randomized comparison of quadruple and triple therapies for helicobacter pylori eradication: The QUADRATE study.
Author(s) Katelaris, Peter H.
Forbes, Geoffrey M.
Talley, Nicolas J.
Crotty, BrendanORCID iD for Crotty, Brendan orcid.org/0000-0002-0592-235X
Journal name Gastroenterology
Volume number 123
Issue number 6
Start page 1763
End page 1769
Publisher W.B. Saounders Co. Ltd.
Place of publication Philadelphia, Pa.
Publication date 2002-12
ISSN 0016-5085
1528-0012
Summary Background & Aims: Direct comparisons of bismuth and proton pump inhibitor (PPI)-based triple and quadruple therapies for Helicobacter pylori eradication are lacking. To address this, a randomized study was conducted.Methods: Infected dyspeptic patients received pantoprazole 40 mg, amoxicillin 1000 mg, and clarithromycin 500 mg, all twice daily, for 7 days (PAC7); or pantoprazole 40 mg twice daily, bismuth subcitrate 108 mg, and tetracycline 500 mg, both 4 times daily, and metronidazole 200 mg 3 times daily and 400 mg at night for 7 days (PBTM7); bismuth subcitrate 108 mg and tetracycline 500 mg, both 4 times daily, and metronidazole 200 mg 3 times daily and 400 mg at night for 14 days (BTM14). Outcome was assessed with 13C-urea breath test.Results: Eradication rates (intention to treat [n = 405]/per protocol [n = 320]) were similar for PAC7 (78%/82%) and PBTM7 (82%/88%); the latter significantly superior to BTM14 (69%/74%; P < 0.01). Pretreatment metronidazole resistance (MR) was 53% and clarithromycin resistance was 8%. Eradication rates for primary metronidazole sensitive/resistant isolates were 74%/87% with PAC7 and 80%/81% for PBTM7, compared with 76%/55% (P < 0.02) for BTM14. Noncompliance was greater with BTM14 (15%; P < 0.001) than PAC7 (3%) or PBTM7 (6%). Moderate-severe adverse events were more common with BTM14 (45%; P < 0.001), than PAC7 (23%) or PBTM7 (25%) with more discontinuations (9%, 2%, 3%, respectively).Conclusions: One-week PPI triple therapy is well tolerated and effective. The addition of PPI to bismuth triple therapy allows reduction of treatment duration with improved efficacy and tolerability, despite a high rate of MR. Quadruple therapy appears to overcome pretreatment MR in most cases. Two-week bismuth triple therapy is significantly inferior to quadruple therapy and less well tolerated than both 1-week therapies.
Notes Available online 7 December 2002.
Language eng
DOI 10.1053/gast.2002.37051
Field of Research 110307 Gastroenterology and Hepatology
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2002, American Gastroenterological Association.
Persistent URL http://hdl.handle.net/10536/DRO/DU:30006577

Document type: Journal Article
Collection: School of Medicine
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