Treatment of Helicobacter pylori infection with low or high dose omeprazole combined with amoxycillin and the effect of early retreatment

Background: Cure rates of H. pylori infection, using dual therapy with omeprazole and amoxycillin, vary considerably and the efficacy of retreatment with this regimen in the case of initial failure is controversial. Therefore, we conducted a large prospective double-blind randomized trial, studying the efficacy of low vs. high dose omeprazole in dual therapy and of early retreatment with the same regimens. Methods: One hundred and sixty-eight consecutive H. pylori-positive patients, suffering from either peptic ulcer disease or functional dyspepsia, were enrolled, Group I (n = 84) received omeprazole 20 mg b.d. plus amoxycillin 750 mg t.d.s., for 2 weeks. Group II (n = 84) received omeprazole 40 mg t.d.s. plus amoxicillin 750 mg t.d.s., for 2 weeks. Results: The H. pylori eradication rate was 60.2% in group I and 64.3% in group II (P = 0.59). Cure of H, pylori infection was significantly better in patients with peptic ulcer disease, compared to non-ulcer dyspeptics (P = 0.016). Retreatment, given in 54 patients, was successful in 21.4% patients in group I and in 28% patients in group II (P = 0.58). Conclusions: High dose of omeprazole has no advantage compared to low dose in terms of eradication efficacy. Early retreatment with the same regimen offers limited improvement in cure rate, Presence of peptic ulcer disease influences cure rates significantly.