The letter by de Boer and Driessen raises important clinical questions regarding the treatment and management of patients with peptic ulcer disease and Helicobacter pylori infection. They quote efficacy for dual therapy with a proton pump inhibitor (omeprazole) plus an antibiotic (amoxicillin or clarithromycin) of 50% to 80% vs eradication of 90% in patients treated with triple therapy (bismuth, tetracycline, and metronidazole). They use these data to recommend that triple therapy remain the "gold standard" of treatment in patients with H pylori.de Boer and Driessen's interpretation of their data and the literature is, indeed, correct in a research setting. The most important variable in eradication rates with any therapeutic regimen is patient compliance with the treatment regimen.1 In a research setting, a patient can be cajoled and even extorted into being compliant, even with the most complex regimens owing to the constant supervision by research staff
Fennerty MB. Treatment of Helicobacter pylori Infection-Reply. Arch Intern Med. 1995;155(3):331. doi:10.1001/archinte.1995.00430030128018
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