zithromax and Peptic-Ulcer

Prospective clinical investigation efficacy of omeprazole was proved in combination with two antibiotics (azithromicine and amoxycillin) in H. pylori eradication. Efficacy of omeprazole was also followed in gastric and duodenal ulcer healing.. Patients with dyspepsia and peptic ulcer of stomach and duodenum were examined. Positive H. pylori status was proved by rapid urease test (Pronto dry). During first 7 days patients were treated with omeprazole (Ulzol caps. 2 x 20 mg), amoxycillin 7 days (Amoxil 2 x 1000 mg), and Azithromicin 3 days (Sumamed 1 x 1000 mg). After that period patients received omeprazole (Ulzol caps. 1 x 20 mg) in single morning dose next 21 or 28 days in continuation of antisecretory treatment. Control endoscopy revealed rate of ulcer healing and rate of H. pylori infection with same test at least 28 days after initiation of treatment.. Complete eradication of H. pylori was in 46/50 (92%) patients (p < 0.001), complete ulcer healing in 48/50 (96%) patients. No patients had complication after omeprazole treatment. Two patients (4%) had worsening of dyspepsia, but without treatment discontinuation.. Triple treatment with omeprazole, azithromicin and amoxycillin achieved high rate of H. pylori eradication, gastric and duodenal ulcer healing. Treatment was well tolerated, with rapid pain and dyspepsia symptoms relief.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Azithromycin; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Omeprazole; Peptic Ulcer; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Anti-Ulcer Agents; Azithromycin; Drug Administration Schedule; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Peptic Ulcer; Prospective Studies; Ranitidine; Treatment Outcome

The high cost and complexity of therapeutic schemes for the eradication of Helicobacter pylori has stimulated the search of simpler and cheaper treatment options.. To evaluate the efficacy of 3 days of azithromycin 500 mg od, 7 days of amoxycillin 750 mg tid and omeprazole, 20 (Group A) or 40 mg (Group B) on randomization, as a treatment for Helicobacter pylori infection in patients with endoscopically diagnosed peptic ulcer.. H. pylori status of peptic ulcer patients was pathologically confirmed by the examination of five gastric biopsies using the Giemsa stain and by rapid urease testing in two gastric biopsies. H. pylori status was reassessed not less than 28 days after completing treatment. Adverse events and compliance were evaluated.. Fifty four patients (29 men, 25 women, mean age 48 years) were enrolled, 28 in Group A and 27 in Group B. Per protocol the infection was cured in 58.8% of patients (30/51; 95% CI: 45-73%). On an intention to treat basis, H pylori infection was cured in 55%. Minor side effects including diarrhea and nausea were reported by 32% of patients. Ninety-five per cent of patients consumed more than 95% of prescribed medications. H. pylori was successfully eradicated in 61% of group A and 57% of group B patients (p = NS).. Short term therapy with azithromycin was poorly effective in curing H. pylori infection. The compliance was excellent. Increasing Omeprazole from 20 to 40 mg/day did not improve treatment effectiveness.

Topics: Amoxicillin; Anti-Ulcer Agents; Azithromycin; Drug Administration Schedule; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Omeprazole; Peptic Ulcer

Azithromycin is new acid-stable macrolide that achieves 10- to 40-fold higher tissue levels than erythromycin after oral dosing. Important to note, the tissue half-life of azithromycin is measured in days instead of hours.. We evaluated two new triple therapies for Helicobacter pylori infection in which azithromycin was substituted for metronidazole either as 250 mg b.i.d. or t.i.d. along with tetracycline 500 mg q.i.d. and bismuth subsalicylate 2 tablets q.i.d. for 14 days. H. pylori status was determined by histology before and 6 wk or more after therapy.. Thirty men with documented H. pylori peptic ulcers completed therapy. Twenty-one also received ranitidine (300 mg in the evening) along with the antimicrobial therapy. H. pylori infection was successfully treated in 15 (50%) (95% CI = 31-69%). The cure rate was significantly higher with the 250-mg-t.i.d.-azithromycin dosage regime (83%) (95% CI = 52-98%) compared to the 250-mg-b.i.d.-dosage regime (28%) (95% CI = 10-53%) (p < 0.01). Troublesome side effects were experienced by the majority of those receiving azithromycin t.i.d.. We conclude that although 750 mg or more of azithromycin might eventually be able to replace metronidazole or clarithromycin in standard triple therapy, additional studies are required to identify a regime that is both effective and tolerable.

Topics: Azithromycin; Bismuth; Drug Administration Schedule; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Organometallic Compounds; Peptic Ulcer; Ranitidine; Salicylates; Tetracycline

The Brazilian consensus recommends a short-term treatment course with clarithromycin, amoxicillin and proton-pump inhibitor for the eradication of Helicobacter pylori (H. pylori). This treatment course has good efficacy, but cannot be afforded by a large part of the population. Azithromycin, amoxicillin and omeprazole are subsidized, for several aims, by the Brazilian federal government. Therefore, a short-term treatment course that uses these drugs is a low-cost one, but its efficacy regarding the bacterium eradication is yet to be demonstrated. The study's purpose was to verify the efficacy of H. pylori eradication in infected patients who presented peptic ulcer disease, using the association of azithromycin, amoxicillin and omeprazole.. Sixty patients with peptic ulcer diagnosed by upper digestive endoscopy and H. pylori infection documented by rapid urease test, histological analysis and urea breath test were treated for six days with a combination of azithromycin 500 mg and omeprazole 20 mg, in a single daily dose, associated with amoxicillin 500 mg 3 times a day. The eradication control was carried out 12 weeks after the treatment by means of the same diagnostic tests. The eradication rates were calculated with 95% confidence interval.. The eradication rate was 38% per intention to treat and 41% per protocol. Few adverse effects were observed and treatment compliance was high.. Despite its low cost and high compliance, the low eradication rate does not allow the recommendation of the triple therapy with azithromycin as an adequate treatment for H. pylori infection.

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin; Azithromycin; Brazil; Drug Administration Schedule; Drug Costs; Drug Therapy, Combination; Duodenal Ulcer; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Omeprazole; Patient Compliance; Peptic Ulcer; Treatment Outcome

Helicobacter pylori infection is highly prevalent and may cause disease in 10% to 15% of infected individuals: duodenal and gastric ulcer, gastric cancer and gastric lymphoma. Guidelines for a test-and-treat policy have been published by the European H. pylori working group in Maastricht.. To assess the current approach to H. pylori-related diseases, indications for testing and eradication therapy, among internists and surgeons of a University affiliated medical center.. A 15-items questionnaire was formulated according to the Maastricht II test-and-treat recommendation and distributed among the physicians of 6 internal medicine departments and the department of surgery. The questionnaires were completed anonymously at the department's staff meeting, under the supervision of the head of the department. All questions required a yes/no answer; the maximum possible score was 15. The relative ratio (RR) of correct answers was calculated for every question and by subgroups as follows: all participants, internists, surgeons, experts and residents in internal medicine and surgery.. The response rate was 68% (55 out of 80 physicians). Total score for all participants was 10.9 (RR = 0.73), significantly lower than the maximum score of 15 (RR = 1.00). The internists had significantly higher average score than the surgeons for 2 questions: causative agent in gastric cancer (p = 0.003) or gastric lymphoma (p = 0.003), 1 question about triple therapy, PPI, penicillin and azythromycin being not recommended (p = 0.022), and for 1 question of test-and-treat policy: should this strategy apply to family members of gastric cancer patients (p = 0.045). Only 56% of the internists and 21% of surgeons knew what MALToma is, and the correlation with H. pylori infection.. Knowledge of Surgeons and Internists regarding infection and correlation with diseases or test and treat policy should be improved.

Topics: Academic Medical Centers; Anti-Bacterial Agents; Azithromycin; Data Collection; Drug Therapy, Combination; Gastritis; General Surgery; Guideline Adherence; Health Knowledge, Attitudes, Practice; Helicobacter Infections; Helicobacter pylori; Humans; Internship and Residency; Israel; Lymphoma, B-Cell, Marginal Zone; Penicillins; Peptic Ulcer; Practice Guidelines as Topic; Referral and Consultation; Stomach Neoplasms

To obtain epidemiological data concerning Helicobacter pylori (H.p.) infections and peptic ulcer in patients with upper abdominal pain in a routine non-hospital based health-insurance practice, as well as to test the efficacy of H.p. eradication, especially with a new shortterm treatment scheme in this setting.. H.p. status and possible peptic ulceration (urease test, biopsies of gastric antrum and body) were determined in 1242 consecutive patients with upper abdominal pain examined gastroscopically. Patients who were H.p. positive and had a peptic ulcer or recurrent gastritis with erosions were given dual or triple medication (lansoprazole or pantoprazole with one or two antibiotics: amoxycillin, clarithromycin, azithromycin, tinidazole), under conditions of controlled compliance.. The H.p. infection rate was 45.9% for the whole group (mean age: 49.9 years). An acute ulceration was found in 10.4% of the whole group, i.e. 20.1% of the 129 H.p. positive patients. 194 patients were given an eradication treatment. In 62 of them, put on a new 6-day eradication regimen (azithromycin, 1 x 500 mg daily; tinidazole, 1 x 2000 mg/d; and pantoprazole, 2 x 40 mg/d), an eradication rate of 93% (under protocol) or 92% (intention to treat) was achieved.. In routine non-hospital practice a 6-day modified triple-medication treatment with azithromycin, tinidazole and pantoprazole proved efficacious in eradicating H.p. infection. It not only caused few side effects and was cheap, but also achieved high patient compliance.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Anti-Ulcer Agents; Azithromycin; Benzimidazoles; Female; Helicobacter Infections; Helicobacter pylori; Humans; Insurance, Physician Services; Male; Middle Aged; Omeprazole; Pantoprazole; Peptic Ulcer; Practice Patterns, Physicians'; Sulfoxides; Time Factors; Tinidazole

Thirty-eight clinical strains of Helicobacter pylori were isolated from patients with chronic gastritis and gastroduodenal ulceration, and their susceptibility to macrolide antibiotics (roxithromycin, flurithromycin, azithromycin, erythromycin) in combination with proton-pump inhibitors (lansoprazole and omeprazole) and bismuth subcitrate was assayed. Chequerboard titration was used to analyse the results of antimicrobial interactions and showed that the activity of macrolides was enhanced by combining them with lansoprazole, omeprazole or, to a lesser extent, bismuth subcitrate. While the interactions between erythromycin and the proton-pump inhibitors or bismuth subcitrate were always additive, the combinations of roxithromycin-lansoprazole, flurithromycin-omeprazole and azithromycin-lansoprazole acted synergically on 82%, 60% and 60% of H. pylori strains, respectively. These results may, in part, account for the enhanced clinical efficacy of macrolides administered with proton-pump inhibitors in the treatment of H. pylori-associated diseases.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Anti-Bacterial Agents; Anti-Ulcer Agents; Azithromycin; Drug Synergism; Erythromycin; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Lansoprazole; Microbial Sensitivity Tests; Omeprazole; Organometallic Compounds; Peptic Ulcer; Proton Pump Inhibitors; Roxithromycin