Two‐day ‘weekend’ lansoprazole‐quadruple therapy for Helicobacter pylori infection

Background: The very high cure rate of 1‐week quadruple therapy offers an opportunity to study a shorter treatment duration. This is needed to construct a time–response curve for the regimen. Methods: Fifty‐two patients with endoscopically proven H. pylori infection received lansoprazole 30 mg b.d., tripotassium dicitrato bismuthate 120 mg q.d.s., tetracycline 500 mg q.d.s. and metronidazole 500 mg q.d.s., following 3 days of lansoprazole pre‐treatment. A second endoscopy was performed at least 6 weeks later. A patient was cured if histology, CLO‐test, and culture of antrum and corpus were negative. Results: We achieved an intention‐to‐treat cure rate of 30/50 (60%, 95% CI: 46–73%) and a per protocol cure rate of 30/48 (63%, 95% CI: 48–75%). Cure rate in metronidazole‐sensitive strains was 24/37 (65%, 95% CI: 48–79%) and 2/5 (40%) in resistant strains. All patients that failed the regimen had a metronidazole‐resistant strain post‐treatment. Compliance was excellent and moderate or severe side‐effects occurred in only 4% of patients. Conclusion: A 2‐day ‘weekend’ quadruple therapy cures only 60% of patients and cannot be recommended, but these findings provide an insight into the mode of action of quadruple therapy.