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Ulcer Treatment: 4 Drugs Better Than 3?

Four-Medication Regimen Beats Out Standard Three-Drug Approach in Study

Ulcer Treatment: Study Details continued...

The four-drug regimen, called LOAD, included:

In all, 135 patients were evaluated, with 45 in each of the three regimens. The average age in all three groups was 46. Some had peptic ulcers, others had gastritis or other gastric conditions linked to the bacteria. All had been off antibiotic or PPI use for six weeks before beginning the new ulcer treatments. None had undergone treatment to eradicate H. pylori before.

Ulcer Treatment Study Results

The four-drug approach eliminated bacteria in more than 95% of all these patients, with the seven-day plan achieving it in 95.3% and the 10-day 95.2%. The three-day approach eliminated it in 80.9%. Physicians say compliance is often a problem, with patients not taking prescribed pills, but Basu found high compliance, with 93.3% of the 10-day LOAD patients and the 10-day LAC patients completing the treatment and 95.6% of the LOAD seven-day patients finishing.

When the analysis was computed to include everyone who began the study, including the eight who discontinued the treatments, the four-drug, seven-day plan eliminated bacteria in 91.1%, the four-drug 10-day plan eliminated it in 88.9%, and the three-drug, 10-day plan eradicated bacteria in 75.6%.

Side effects reported by all groups were mostly minor, such as headache, belching, or constipation.

All patients he studied had not received treatment before, so Basu can't yet say whether the new plan might be worth a try for those who have failed previous treatment.

Costs are comparable, Basu says. "LAC is about $400 for 10 days, and LOAD is about $400 for seven days. LOAD 10 is about $535."

Second Opinion

''It's a completely new regimen," says William Chey, MD, professor of medicine at the University of Michigan, Ann Arbor, who reviewed the study findings for WebMD.

He views the results as promising. "This is exciting news about a potential new therapy," he says. New treatment regimens have been few in recent years, he says, as the percentage of people with H. pylori in the U.S. has dropped steadily.

What strengthens the study finding that the four-day approach is more effective, he says, is that "the eradication rate he got with [the three-day approach] is exactly what you would expect based on other studies from the U.S." In his recent review of published studies, Chey found an eradication rate of about 77% with three-drug treatment plans, close to the 80% found in the new study.

Physicians should consider the new four-drug regimen, he says, adding that further studies are needed. "The results are encouraging, and the eradication rates with standard therapy are not very good."

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