The first therapies to reliably eradicate Helicobacter pylori used combinations of bismuth, metronidazole, and tetracycline or amoxicillin. The increasing frequency of metronidazole resistance, however, has limited the effectiveness of the original combination therapies. As with the use of bismuth compounds, proton pump inhibitors can be used to kill H pylori but are themselves insufficient to eradicate the infection. Proton pump inhibitors markedly increase gastric pH. Because this action may make antimicrobials more effective, we evaluated omeprazole as an adjuvant to antimicrobial therapy. We tested omeprazole 20 mg TID for 7 days as an adjuvant to oral clarithromycin 500 mg TID or gentamicin 20 mg TID (each was given for the final 5 days of the 7-day treatment course). Eradication was defined as the absence of evidence of H pylori 4 or more weeks after cessation of therapy. Eleven patients with active peptic ulcer disease were treated with omeprazole/clarithromycin; the eradication rate was 64%. Six healthy H pylori-infected volunteers were treated with omeprazole/gentamicin; no eradication was achieved. Omeprazole appears to be a useful adjuvant to some therapies but the results cannot be predicted. Combination therapy with omeprazole and clarithromycin warrants further study.
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