Clarithromycin versus metronidazole as first-line helicobacter pylori eradication

Toshihiro Nishizawa, Takama Maekawa, Noriko Watanabe, Naohiko Harada, Yasuo Hosoda, Masahiro Yoshinaga, Toshiyuki Yoshio, Hajime Ohta, Syuuji Inoue, Tatsuya Toyokawa, Haruhiro Yamashita, Hiroki Saito, Toshio Kuwai, Shunsuke Katayama, Eiji Masuda, Hideharu Miyabayashi, Toshio Kimura, Yuko Nishizawa, Masahiko Takahashi, Hidekazu Suzuki

Research output: Contribution to journalArticlepeer-review

56 Citations (Scopus)


Background: Helicobacter pylori eradication rates achieved with a first-line regimen of clarithromycin (CLR) combined with amoxicillin (AMX) and a proton pump inhibitor have recently fallen to ≤80% because of the increasing incidence of CLR resistance in Japan. This randomized multicenter trial aimed to compare the eradication success of 2 first-line triple therapy regimens: rabeprazole, amoxicillin, and clarithromycin (RAC) versus rabeprazole, amoxicillin, and metronidazole (RAM). Methods: A total of 124 consecutive patients infected with H. pylori were randomized into one of two 7-day therapeutic regimens: RAC (n=60) or RAM (n=64). Eradication was confirmed by the 13 C-urea breath test. Adverse effects were also assessed. Results: Intention-to-treat and per protocol H. pylori eradication rates were 73.3%/77.2% in the RAC group and 90.6%/93.5% in the RAM group. The eradication rate of RAM therapy was significantly higher than that of RAC therapy. CLR, metronidazole, and AMX resistance was found in 36.2%, 2.1%, and 0% of patients, respectively. In addition, no relevant differences in adverse effects were observed. Conclusions: Metronidazole-based therapy (RAM) was superior to standard CLR-based therapy (RAC) for first-line H. pylori eradication. This reflects the progressive increase in CLR resistance observed in Japan.

Original languageEnglish
Pages (from-to)468-471
Number of pages4
JournalJournal of Clinical Gastroenterology
Issue number6
Publication statusPublished - 2015 Jun 24


  • Helicobacter pylori
  • clarithromycin
  • eradication
  • metronidazole

ASJC Scopus subject areas

  • Gastroenterology


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