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It has been suggested that despite resistance, metronidazole may be effective when given at high dose with bismuth, tetracycline, and a proton pump inhibitor (quadruple therapy).<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim:<\/jats:title><jats:p>To prospectively evaluate metronidazole quadruple therapy for treatment of metronidazole resistant <jats:italic>H. pylori<\/jats:italic> infection in the United States.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>Patients infected with metronidazole resistant <jats:italic>H. pylori<\/jats:italic> were prospectively prescribed 14\u2003days of quadruple therapy consisting of metronidazole 500\u2003mg t.d.s., tetracycline 500\u2003mg q.d.s., two bismuth subsalicylate tablets q.d.s., and omeprazole 20\u2003mg o.d.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>A total of 26 patients were entered into the study; 22 for their first treatment and four as re\u2010treatment for failed therapy. Of the 26 patients, 24 were cured (cure rate 92%; 95% CI: 78\u201399%). Both treatment failures reported full compliance to 14\u2003days of therapy. Side\u2010effects were common and resulted in premature discontinuation of therapy in 31%. Premature discontinuation did not reduce the cure rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion:<\/jats:title><jats:p>Quadruple metronidazole combination therapy is effective despite the presence of metronidazole resistance and should be considered as either first line therapy or for failures of twice\u2010a\u2010day combination therapies.<\/jats:p><\/jats:sec>","DOI":"10.1046\/j.1365-2036.2000.00770.x","type":"journal-article","created":{"date-parts":[[2003,3,11]],"date-time":"2003-03-11T03:41:49Z","timestamp":1047354109000},"page":"745-750","source":"Crossref","is-referenced-by-count":63,"title":["Metronidazole containing quadruple therapy for infection with metronidazole resistant <i>Helicobacter pylori:<\/i> a prospective study"],"prefix":"10.1111","volume":"14","author":[{"family":"Graham","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Osato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Hoffman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Opekun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Anderson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Kwon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"El\u2010Zimaity","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2001,12,24]]},"reference":[{"key":"e_1_2_6_2_2","unstructured":"GrahamDY&DoreMP.Variability in the outcome of treatment ofHelicobacter pyloriinfection: a critical analysis. 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