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Background: Azithromycin is an acid-stable macrolide that achieves remarkably high concentrations in gastric tissue, persisting above the MIC 90 for Helicobacter pylori over a period of 5-days, after a single 500 mg oral dose.

Aim: To evaluate and compare the efficacy, safety, and tolerability of two eradicating regimens of pantoprazole, azithromycin and tinidazole.

Methods: A total of 100 consecutive symptomatic H. pylori- positive patients received pantoprazole 40 mg b.d. for 1 week, and were randomly assigned to either azithromycin 500 mg o.m. and tinidazole 500 mg b.d. during the first 3 days (early group, n =50) or during the last 3 days of therapy with pantoprazole (late group, n =50). H. pylori status was assessed by histology and rapid urease test at entry and by histology and 13 C-urea breath test 1 month after the end of the therapy.

Results: Ninety-nine patients completed the study. H. pylori was eradicated in 86% of patients in the early group (intention-to-treat 86%) and in 88% of patients in the late group (intention-to-treat 88%).

Conclusions: This short triple therapy is effective for H. pylori eradication. The compliance was excellent and side-effects negligible. Moreover, the pantoprazole pre-treatment did not modify the efficacy of the therapy.

(C) 2000 Blackwell Science Ltd.