In his excellent review on Helicobacter pylori, Fennerty1 fails to address a new and promising direction in the treatment of H pylori infection. Fennerty favors the use of dual therapy with omeprazole plus one antibiotic, a regimen with a wide range of reported efficacies and from which eradication in only 50% to 80% of patients thus treated can be expected. Many questions about this therapy still exist.2 If we accept that eradication means "cure," eradication is the purpose in 100% of patients. This means that 20% to 50% of patients need another treatment and need to undergo extra diagnostic procedures, usually endoscopies! Considering that might tip the balance of a seemingly easier therapy back to a more efficacious one.
Fennerty seems to reject triple therapy for its supposed complexity and poor tolerability. Traditional triple therapy with bismuth, tetracycline, and metronidazole, however, gives far more consistent eradication rates of