This article has Open Peer Review reports available.
Short-term triple therapy with azithromycin for Helicobacter pylori eradication: Low cost, high compliance, but low efficacy
© Silva et al; licensee BioMed Central Ltd. 2008
Received: 12 September 2007
Accepted: 29 May 2008
Published: 29 May 2008
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.
Several therapy courses have been employed in the eradication of the bacterium, with the use of drugs such as bismuth, clarithromycin, amoxicillin, furazolidone, nitroimidazole compounds and proton pump inhibitors, in assorted combinations [7–11].
The search for low-cost and higher efficacy with fewer adverse effects, that can allow higher compliance to H. pylori eradication therapy, is a vital concern [12–16]. In Brazil, where several particular situations are present, such as higher bacterial resistance to antibiotics [17, 18], special health conditions  and low socioeconomic status of the population [20, 21], this task is even more delicate.
The macrolides are among the antibiotics that used alone, present high rates of bacterium eradication, with few adverse effects and simple regimen, especially clarithromycin [22, 23], although its previous use, similarly to what occurs with nitroimidazole drugs, can determine secondary bacterial resistance .
In Brazil, the triple therapy with amoxicillin and clarithromycin, associated to a proton pump inhibitor for 7 days, has attained good eradication rates , possibly because this therapy has high compliance and presents low bacterial resistance [18, 26–28]. Hence, it has been recommended as a first choice treatment in a national consensus , although with a high cost (around US$75.00).
Azithromycin, a macrolide with a long term action [29, 30], is part of the assortment of drugs available for H. pylori treatment [31–34]. However, some studies have shown low eradication rates [35, 36]. In our country, a study has shown good efficacy of this antibiotic when associated with furazolidone . Although another study of our group, associating azithromycin with secnidazole in an ultra-fast treatment course, presented low efficacy .
The Public Health services in our country do not provide any eradication treatment for H. pylori, free of charge. However, the federal government subsidizes, among other drugs, the acquisition of omeprazole, azithromycin and amoxicillin, through its Popular Pharmacy program . With the objective of offering a low-cost treatment to eradicate the bacterium (in this case, at a cost of US$10.00) we tested a 6-day drug therapy with azithromycin associated with amoxicillin and omeprazole.
Sixty outpatients with H. pylori positive peptic ulcer, followed at the Service of Gastroenterology of Clinics Hospital of the Medical School, University of São Paulo were randomly invited to participate in the study. All patients signed a free and informed consent form prior to enrollment. The study was approved by the Ethics Committee of the hospital.
Inclusion and exclusion criteria
The inclusion criteria were: peptic ulcer diagnosed by upper digestive endoscopy, and H. pylori infection, confirmed by rapid urease test, histological analysis and the Urea Breath Test (UBT).
The exclusion criteria were: age younger than 16 or older than 90 years, chronic use of acetylsalicylic even at low doses, or other anti-inflammatory drugs, previous use of macrolides, use of antibiotics or chemotherapeutic drugs in the 4 weeks prior to study enrollment, having complicated peptic ulcer, pyloric stenosis, previous gastric surgery, erosive esophagitis, to be pregnant or breastfeeding, having consumptive diseases or not controlled renal, heart or hepatic failure, having been previously treated for H. pylori eradication or having participated in any other clinical studies in the two months prior to the study enrollment.
The eradication treatment was carried out with omeprazole 20 mg and azithromycin 500 mg in a single daily dose taken in fasting condition in the morning, associated with amoxicillin 500 mg, taken three times a day immediately after meals, for six days.
The adverse effects and the compliance were documented on the first day after the end of the treatment. The type, intensity and duration of the adverse effects were recorded. The medication blisters were assessed and the remaining tablets or capsules were counted.
Treatment control was carried out 10 to 12 weeks after the end of treatment, when the UBT and an upper digestive endoscopy done. Samples from corpus and antrum mucosa were colleted to perform the rapid urease test and histological analysis.
Patients were considered cured when they presented negative results in at least two of the performed tests and, in case of discordant test results, a new UBT was performed two months after the control.
The symptomatic patients were allowed to use antacid medication after the drug therapy up to the time when the eradication control tests were performed.
The statistical analysis was carried out with the SPSS program, version 10.0 (SPSS Inc. USA).
The sample calculation was determined by means of a descriptive study of one dichotomous variable, in which the prevalence of peptic ulcer disease in the general population was assumed to be 8% and the lower bacterium eradication efficacy was 75%. The eradication rates were studied per intention to treat and per protocol. All of the patients included in the study were considered for the analysis of per intention to treat. The patients who took most of the medication adequately and came back for the control evaluation were considered for the per protocol analysis. The 95% confidence interval was determined for the eradication rates.
Characteristics of the studied population.
21 – 83
Peptic ulcer risk
Peptic ulcer type
Gastric + Duodenal
Duodenal ulcers were present in 52% of the patients. Cigarette smoking was reported by 35%. Four patients not return for the eradication control. One of these patients withdrew the medication after only two days, due to the presence of diarrhea. Adverse effects were reported by 20 of the 60 patients included in study (33%), being considered mild by 17 patients (28%), moderate by two patients (3%) and severe by only one patient, who withdrew the treatment. The most frequent adverse effects were diarrhea (22%) and nausea (5%).
Rate and percentage
Confidence interval (95%)
Intention to treat
51 – 26%
54 – 28%
In Brazil, the majority of the population depends on public health services to have access to healthcare . In addition, part of the population that has private health insurance or can afford private healthcare services, depends on the government's subsidy or free medication programs to obtain the drugs. Some healthcare programs such as the tuberculosis , AIDS , as well as the diabetes or hypertension  warrant free medication to all of the Brazilian population. Although it is a consensus that the curative treatment of peptic ulcer disease depends on the eradication of the H. pylori  and that the cost benefit ratio is favorable regarding this approach , the government does not provide any eradication strategy free of charge through the public health system.
The country has characteristics of a developing country, regarding the aspect of income distribution [20, 21], as well as the prevalence (quite high) of H. pylori infection [46–49], with the bacterium being resistant to many antibiotics . However, the treatment with a proton pump inhibitor, amoxicillin and clarithromycin has reached good eradication rates , close to those observed in developed countries  and differently from those observed with the association of proton pump inhibitor, nitroimidazoles and clarithromycin [51, 52], possibly due to the primary resistance of H. pylori to these compounds [17, 18]. There are different packs of triple treatments in the Brazilian market, associating a proton pump inhibitor, amoxicillin and clarithromycin, presented in blisters for daily use during 7 days of treatment, which favors treatment compliance and control [53, 54]. However, due to its cost, it cannot be afforded by the majority of the population.
Azithromycin has an in vitro bactericidal effect against H. pylori  and this study assessed its administration in association with amoxicillin for six days. As azithromycin, omeprazole and amoxicillin are subsidized by the Brazilian federal government , this treatment approach could be a powerful and low-cost weapon for the treatment of these diseases in our country. It is also noteworthy the pharmacokinetic characteristics of azithromycin , which can provide a shorter treatment and favor the patients' compliance. Mild and tolerable adverse effects can be expected, similar to those observed with clarithromycin therapy.
Several studies obtained good efficacy in H. pylori eradication with short-term triple therapy using azithromycin, amoxicillin and a proton pump inhibitor [59–61]. Probably better efficacy can be achieved with a higher dose of azithromycin .
The present study has indeed showed high compliance and a few significant adverse effects; however, low eradication rates were observed. It is important to stress that, a macrolide use can probably decrease future treatment efficacy, when these compounds are reutilized.
Although azithromycin is a macrolide that reaches high concentration in plasma and in the gastric mucosa, the low eradication rates can be explained by its low concentration in the gastric juice . It is noteworthy that a study observed an eradication rate of 80% 30 days after the treatment and 20% after 60 days, which suggests a temporary suppression of the infection .
The short term therapy for H. pylori eradication using azithromycin 500 mg and omeprazole 20 mg in a single daily dose, associated with amoxicillin 500 mg three times a day resulted in few adverse effects, and high compliance with low costs. But low eradication rates observed with this approach do not allow recommending it as an alternative treatment.
The authors wish to thank Ache Pharmaceuticals, S.A. for providing the drugs Omeprazole, Amoxicillin and Azithromycin used in the study.
- NIH Consensus Development Panel on H. pylori in peptic ulcer disease: Helicobacter pylori in peptic ulcer disease. JAMA. 1994, 272: 65-69. 10.1001/jama.272.1.65.View ArticleGoogle Scholar
- Malfertheiner P, Megraud F, O'Morain C, Hungin APS, Jones R, Axon A, Grahan DY, Tytgat GI, European Helicobacter pylori Study Group (EHPSG): Current concepts in the management of Helicobacter pylori infection – The Maastricht 2 – 2000 Consensus report. Aliment Pharmacol Ther. 2002, 16: 167-80. 10.1046/j.1365-2036.2002.01169.x.View ArticlePubMedGoogle Scholar
- Lam SK, Talley NJ: Report of the 1997 ASIA Pacific Consensus Conference on the management of Helicobacter pylori infection. J Gastroenterol Hepatol. 1998, 13: 1-12. 10.1111/j.1440-1746.1998.tb00537.x.View ArticlePubMedGoogle Scholar
- Hunt RH, Fallone CA, Veldhuyzan van Zanten S, Sherman P, Smaill F, Flook N, Thomson A, CHSG 2004 participants: Canadian Helicobacter Study Group Consensus Conference: Update on the management of Helicobacter pylori – an evidence-based evaluation of six topics relevant to clinical out comes in patients evaluated for H. pylori infection. Can J Gastroenterol. 2004, 18: 547-54.View ArticlePubMedGoogle Scholar
- Coelho LVG, Zaterka S, representatives of the Brazilian Federation of Gastroenterology and Brazilian Nucleus for the study of Helicobacter pylori: Second Brazilian Consensus Conference on Helicobacter pylori Infection. Arq Gastroenterol. 2005, 42: 128-32.PubMedGoogle Scholar
- Coelho LGV, Leon-Barua R, Quigley EMM: Latin-American Consensus Conference on Helicobacter pylori infection. Am J Gastroenterol. 2000, 95: 2688-91.View ArticlePubMedGoogle Scholar
- Unge P, Berstad A: Pooled analysis of anti-Helicobacter pylori treatment regimens. Scand J Gastroentrol Suppl. 1996, 220: 27-40. 10.3109/00365529609094747.View ArticleGoogle Scholar
- Pipkin GA, Williamson R, Wood JR: Review article: one-week clarithromycin triple therapy regimens for eradication of Helicobacter pylori. Aliment Pharmacol Ther. 1998, 12: 823-37. 10.1046/j.1365-2036.1998.00405.x.View ArticlePubMedGoogle Scholar
- Chiba N, Rao BV, Rademaker JW, Hunt RH: Meta-analysis of the efficacy of antibiotic therapy in eradicating Helicobacter pylori. Am J Gastroenterol. 1992, 87: 1716-27.PubMedGoogle Scholar
- Guo CY, Wu YB, Liu HL, Wu JY, Zhong MB: Clinical evaluation of four one-week triple therapy regimens in eradicating Helicobacter pylori infection. World J Gastroenterol. 2004, 10: 747-9.View ArticlePubMedPubMed CentralGoogle Scholar
- Cammarota G, Cianci R, Cannizzaro O, Cuoco L, Pirozzi G, Gasbarrini A, Armuzzi A, Zocco MA, Santarelli A, Arancio F, Gasbarrini G: Efficacy of two one-week rabeprazole/levoflaxacin-based triple therapies for Helicobacter pylori infection. Aliment Pharmacol Ther. 2000, 14: 1339-43. 10.1046/j.1365-2036.2000.00846.x.View ArticlePubMedGoogle Scholar
- Glupczynski I, Burette A: Drug therapy for Helicobacter pylori infection: Problems and pitfalls. Am J Gastroenterol. 1990, 85: 1545-51.PubMedGoogle Scholar
- Cutler AF, Schubert TT: Patient's factors affecting Helicobacter pylori eradication with triple therapy. Am J Gastroenterol. 1993, 88: 505-9.PubMedGoogle Scholar
- Pipkin GA, Williamson R, Wood JR: Review article: one-week clarithromycin triple therapy regimens for eradication of Helicobacter pylori. Aliment Pharmacol Ther. 1998, 12: 823-837. 10.1046/j.1365-2036.1998.00405.x.View ArticlePubMedGoogle Scholar
- Qasin A, O'Morain CA: Review article: Treatment of Helicobacter pylori infection and factors influencing eradication. Aliment Pharmacol Ther. 2002, 24-30. 10.1046/j.1365-2036.2002.0160s1024.x. suppl 1Google Scholar
- Vakil N: Helicobacter pylori: factors affecting eradication e recurrence. Am J Gastroenterol. 2005, 100: 2393-4. 10.1111/j.1572-0241.2005.00286.x.View ArticlePubMedGoogle Scholar
- Queiroz DMM, Coimbra RS, Mendes EN, Rocha GA, Alves VM, Oliveira CA, Lima Júnior GF: Metronidazole resistant Helicobacter pylori in a developing country. Am J Gastroenterol. 1993, 88: 322-3.PubMedGoogle Scholar
- Mendonça S, Ecclissato C, Sartori MS, Godoy AP, Guerzone RA, Degger M, Pedrazzoli J: Prevalence of Helicobacter pylori resistance to metronidazole, clarithromycin, amoxicillin, tetracycline, and furazolidone in Brazil. Helicobacter. 2000, 5: 79-83. 10.1046/j.1523-5378.2000.00011.x.View ArticlePubMedGoogle Scholar
- Risi Júnior JB, Nogueira RP: As condições de saúde no Brasil – Retrospecto 1979 a 1995. 2000, Rio de Janeiro: Editora Fiocruz, [http://www.fiocruz.br/editora/media/04-CSPB02.pdf]Google Scholar
- Quadros WJ, Antunes DJN: Classes sociais e distribuição de renda no Brasil dos anos noventa. Cadernos do CESIT. 2001, n: 30-[http://www.eco.unicamp.br/Downloads/publicacoes/cesit/cadernodoCESIT30.pdf]Google Scholar
- Salário Mínimo e distribuição de renda: Nota técnica – DIEESE. 2005, n.6, [http://www.dieese.org.br/notatecnica/notatecSMDR.pdf]Google Scholar
- Huang J, Hunt RH: The importance of clarithromycin dose in the management of Helicobacter pylori infection: a meta-analysis of triple therapies with a proton pump inhibitor, clarithromycin and amoxicillin or metronidazole. Aliment Pharmacol Ther. 1999, 13: 719-29. 10.1046/j.1365-2036.1999.00530.x.View ArticlePubMedGoogle Scholar
- Goddard AF, Spiller RC: Helicobacter pylori eradication in clinical practice: one-week low-dose triple therapy is preferable to classical bismuth based triple therapy. Aliment Pharmacol Ther. 1996, 10: 1009-13. 10.1046/j.1365-2036.1996.95267000.x.View ArticlePubMedGoogle Scholar
- Peitz U, Sulliga M, Wolle K, Leodolter A, Von Armim U, Kahl S, Stolte M, Börsch G, Labens J, Malfertheiner P: High rate of post-therapeutic resistance after failure of macrolide-nitroimidazole triple therapy to cure Helicobacter pylori infection: impact of two second-line therapies in a randomized study. Aliment Pharmacol Ther. 2002, 16: 315-24. 10.1046/j.1365-2036.2002.01173.x.View ArticlePubMedGoogle Scholar
- Coelho LGV, Mattos AA, Francisconi CFM, Castro LP, Andre SB: Efficacy of the dosing regimen of pantoprazole 40 mg, amoxicillin 1000 mg and clarithromycin 500 mg, twice daily for 7 days, in the eradication of the Helicobacter pylori in patients with peptic ulcer. Arq Gastroenterol. 2004, 41: 71-6.View ArticlePubMedGoogle Scholar
- Ecclissato T, Marchioretto MAM, Mendonça S, Godoy AP, Guersoni RA, Deguer M, Piovesan H, Ferraz JG, Pedrazzoli J: Increased primary resistance to recommended antibiotics negatively affects Helicobacter pylori eradication. Helicobacter. 2002, 7: 53-9. 10.1046/j.1523-5378.2002.00056.x.View ArticlePubMedGoogle Scholar
- Magalhaes PP, Queiroz DMM, Barbosa DVC, Rocha GA, Mendes EN, Santos A, Valle Corrêa PR, Camargos Rocha AM, Martins Teixeira L, Affonso de Oliveira C: Helicobacter pylori primary resistance to Metronidazole and Clarithromycin in Brazil. Antimicrob Agents Chemother. 2002, 46: 2021-3. 10.1128/AAC.46.6.2021-2023.2002.View ArticleGoogle Scholar
- Godoy APO, Ribeiro ML, Benvengo YHB, Vitiello L, Miranda MC, Mendonça S, Pedrazzoli J: Analysis of antimicrobial susceptibility and virulence factors in Helicobacter pylori clinical isolates. BMC Gastroenterol. 2003, 3: 20-10.1186/1471-230X-3-20.View ArticlePubMedPubMed CentralGoogle Scholar
- Retsema J, Girard A, Schelkly W, Manousos M, Anderson M, Bright G, Borovoy R, Brennan L, Mason R: Spectrum and mode of action of azithromycin (CP-62,993), a new 15-membered-ring macrolide with improved potency against gram-negative organisms. Antimicrob Agents Chemother. 1987, 31: 1939-47.View ArticlePubMedPubMed CentralGoogle Scholar
- Blandizzi C, Malizia T, Gherardi G, Costa F, Marchi S, Marveggio C, Natale G, Senesi S, Bellini M, Maltinti G, Campa M, Tacca MD: Gastric mucosal distribution and clinical efficacy of azithromycin in patients with Helicobacter pylori related gastritis. J Antimicrob Chemother. 1998, 42: 75-82. 10.1093/jac/42.1.75.View ArticlePubMedGoogle Scholar
- Di Mario F, Dal Bó N, Grassi AS, Cannizzaro O, Armuzzi A, Gasbarrini A, Addolorato G, Gasbarrini GB: Azithromycin for the cure of Helicobacter pylori infection. Am J Gastroenterol. 1996, 91: 264-7.PubMedGoogle Scholar
- Caselli M, Trevisani L, Tursi A, Sartori S, Ruina M, Luzzi I, Gaudenzi P, Alvisi V, Gasbarrini G: Short-term low-dose triple therapy with azithromycin, metronidazole and lansoprazole appears highly effective for the eradication of Helicobacter pylori. Eur J Gastroenterol Hepatol. 1997, 9: 45-8.View ArticlePubMedGoogle Scholar
- Chey WD, Fisher L, Barnett J, Delvalle J, Elta GH, Hasler WL, Nostrant T, Palaniappan J, Scheiman J: Low-versus high-dose azithromycin triple therapy for Helicobacter pylori infection. Aliment Pharmacol Ther. 1998, 12: 1263-7. 10.1046/j.1365-2036.1998.00422.x.View ArticlePubMedGoogle Scholar
- Calabrese C, Di Febo G, Areni A, Scilapi C, Biasco G, Miglioni M: Pantoprazole, azithromycin and tinidazole: short duration triple therapy for eradication of Helicobacter pylori infection. Aliment Pharmacol Ther. 2000, 14: 1613-17. 10.1046/j.1365-2036.2000.00879.x.View ArticlePubMedGoogle Scholar
- Chahine C, Moukhachen O, Chedid M, Araj GF, Sharara AI: Ultrashort regimen of lansoprazole-amoxicillin-azithromycin for eradicating Helicobacter pylori. Am J Health Syst Pharm. 2001, 58: 1819-23.PubMedGoogle Scholar
- Sullivan B, Coyle W, Nemec R, Dunteman T: Comparison of azithromycin and clarithromycin in triple therapy regimens for the eradication of Helicobacter pylori. Am J Gastroenterol. 2002, 97: 2536-9. 10.1111/j.1572-0241.2002.06036.x.View ArticlePubMedGoogle Scholar
- Coelho LG, Vieira WL, Passos MC, Chausson Y, Castro FJ, Franco JM, Yazaki FR, Costa AC, Andrade JM, Castro LP: Azithromycin, furazolidone and omeprazole: a promising low-dose, low cost, short-term, anti-H. pylori triple therapy. Gastroenterology. 1998, 114: G0382-10.1016/S0016-5085(98)80379-X.View ArticleGoogle Scholar
- Silva FM, Eisig JN, Chether EZ, da Silva JJ, Laudanna AA: Low efficacy of an ultra-short term, once-daily dose triple therapy with omeprazole, azithromycin and secnidazole for Helicobacter pylori eradication in peptic ulcer. Rev Hosp Clin Fac Med Sao Paulo. 2002, 57: 9-14.PubMedGoogle Scholar
- Ministério da Saúde. Farmácia Popular do Brasil. [http://portal.saude.gov.br/portal/arquivos/pdf/medicamentosfarmaciapopular.pdf]
- Pessoto UC, Helmann LS, Boaretto RC, Castro IEN, Kayano J, Ibanhes LC, Junqueira V, Rocha JL, Barboza R, Cortizo CT, Martins LC, Luiz OC: Health care services utilizations and access inequalities in the Sao Paulo Metropolitan region. Cienc Saude Coletiva. 2007, 12 (2): 351-62. [http://www.scielo.br/pdf/csc/v12n2/a11v12n2.pdf]View ArticleGoogle Scholar
- Ministério da Saúde – Brasil. Programa Nacional de Controle da Tuberculose. [http://portal.saude.gov.br/portal/saude/visualizar_texto.cfm?idtxt=21446]
- Ministério da Saúde – Brasil. Programa Nacional de DST e AIDS. [http://portal.saude.gov.br/portal/saude/visualizar_texto.cfm?idtxt=21446]
- Ministério da Saúde – Brasil. Hiperdia – Sistema de cadastramento e acompanhamento de diabéticos e hipertensos. [http://hiperdia.datasus.gov.br/]
- Arkkila PE, Seppala K, Kosunen TU, Sipponen P, Makinen J, Rautelin H, Färkkilä M: Helicobacter pylori eradication as the sole treatment for gastric and duodenal ulcers. Eur J Gastroenterol Hepatol. 2005, 17: 93-101. 10.1097/00042737-200501000-00018.View ArticlePubMedGoogle Scholar
- Ford AC, Delaney BC, Forman D, Moayyedi P: Eradication therapy in Helicobacter pylori positive peptic ulcer disease: Systematic review and economic analysis. Am J Gastroenterol. 2004, 99: 1833-55. 10.1111/j.1572-0241.2004.40014.x.View ArticlePubMedGoogle Scholar
- Zaterka S, Eisig JN, Chinzon D, Rothstein W: Factors related to Helicobacter pylori prevalence in adult population in Brazil. Helicobacter. 2007, 12: 82-8. 10.1111/j.1523-5378.2007.00474.x.View ArticlePubMedGoogle Scholar
- Almeida Cunha RP, Alves FP, Rocha AM, Rocha GA, Camargo LM, Nogueira PO, Camargo EP, Queiroz DM: Prevalence and risk factors associated with Helicobacter pylori infection in native populations from Brazilian Western Amazon. Trans R Soc Trop Med Hyg. 2003, 97: 382-6. 10.1016/S0035-9203(03)90063-0.View ArticlePubMedGoogle Scholar
- Lira AC, Santana G, Santana N, Silvany-Neto A, Magalhães E, Pereira EM, Mascarenhas R, Lyra MC, Veiga A, Ferreira K, Zaterka S, Lyra LG: Seroprevalence and risk factors associated with Helicobacter pylori infection in blood donors in Salvador, Northeast-Brazil. Braz J Infect Dis. 2003, 7: 339-45.Google Scholar
- Rodrigues MN, Queiroz DMM, Bezerra Filho JG, Pontes LK, Rodrigues LT, Braga LL: Prevalence of Helicobacter pylori infection in children from an urban community in north-east Brazil and risk factors for infection. Eur J Gastroenterol Hepatol. 2004, 16: 201-5. 10.1097/00042737-200402000-00013.View ArticlePubMedGoogle Scholar
- Gisbert JP, Gonzales L, Calvet X, Garcia N, Lopes T, Roque M, Gabriel R, Pajares JM: Proton pump inhibitor, clarithromycin and either amoxicillin or nitroimidazole: a metanalysis of eradication of Helicobacter pylori. Aliment Pharmacol Ther. 2000, 14: 1319-28. 10.1046/j.1365-2036.2000.00844.x.View ArticlePubMedGoogle Scholar
- Silva FM, Zaterka S, Eisig JM, Chehter EZ, Chinzon D, Laudanna AA: Factors affecting Helicobacter pylori eradication using a seven-day triple therapy with a proton pump inhibitor, tinidazole and clarithromycin in Brazilian patients with peptic ulcer. Rev Hosp Clin Fac Med S Paulo. 2001, 56: 11-6.View ArticlePubMedGoogle Scholar
- Eisig JN, Andre SB, Silva FM, Hashimoto C, Moraes-Filho JPP, Laudanna AA: The impact of Helicobacter pylori resistance on the efficacy of a short course pantoprazole based triple therapy. Arq Gastroenterol. 2003, 40: 55-60. 10.1590/S0004-28032003000100012.View ArticlePubMedGoogle Scholar
- Pylori Pac*. Medley, Braz. Medley S.A. Indústria Farmacêutica. [http://www.medley.com.br/src/Area.asp?areaid=%7BCCD7A143-D80E-41B2-A191-81F0101C3DEB%7D]
- Omepramix*. Ache, Braz. Aché Laboratórios Farmacêuticos SA. [http://www.ache.com.br/scripts/produtos/produto_bula.asp?idProduto=63&stProduto=Omepramix]
- Lotufo PA, Benseñor IJ, Lolio CA: [Trends of peptic ulcer mortality in São Paulo State (Brazil) 1970–1989]. Arq Gastroenterol. 1994, 31: 130-134. Article in PortuguesePubMedGoogle Scholar
- Lourenço LG, Hamada GS: Gastric cancer in Brazil. Gastric cancer. 2001, 4 (2): 103-105. 10.1007/PL00011722.View ArticlePubMedGoogle Scholar
- Kitzis MD, Goldstein FW, Miégi M, Acar JF: In vitro activity of azithromycin against various gran-negative bacilli and anaerobic bacteria. J Antimicrob Chemother. 1990, 25 Suppl A: 15-18.View ArticlePubMedGoogle Scholar
- Rapp RP: Pharmacokinetics and pharmacodynamics of intravenous and oral azithromycin: enhanced tissue activity and minimal drugs interactions. Ann Pharmacother. 1998, 32: 785-93. 10.1345/aph.17299.View ArticlePubMedGoogle Scholar
- Bertoni G, Sassatelli R, Nigrisoli E, Tansini P, Bianchi G, Della Casa G, Bagni A, Bedogni G: Triple therapy with azithromycin, omeprazole, and amoxicillin is highly effective in the eradication of Helicobacter pylori: a controlled trial versus omeprazole plus amoxicillin. Am J Gastroenterol. 1996, 91: 258-63.PubMedGoogle Scholar
- Vcev A, Vceva A, Takac B, Dmitroviæ B, Stimac D, Stimac T, Kovac D, Pezeroviæ D, Blazanoviæ A, Ivandiæ A, Karner I: Omeprazole, azithromycin and amoxicillin or amoxicillin plus clavulanic acid in eradication of Helicobacter pylori in duodenal ulcer disease. Acta Med Croatica. 1998, 52: 209-14.PubMedGoogle Scholar
- Gribajceviæ M, Vanis N, Mesihoviæ R: Clinical effectiveness of omeprazole, azithromycin and amoxicillin in ulcer healing and eradication of Helicobacter pylori infection. Med Arh. 2003, 57 (1 Suppl 2): 107-10.Google Scholar
- Krichhoff R, Laufen H, Schacke G, Kirchhoff G, Gallo E: Determination of Azithromycin in gastric biopsy samples. Int J Clin Pharmacol Ther. 1999, 37: 361-364.PubMedGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-230X/8/20/prepub
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.