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Influence of metronidazole resistance on efficacy of quadruple therapy for Helicobacter pylori eradication
  1. Bishop Auckland General Hospital,
  2. Cockton Hill Road,
  3. Bishop Auckland,
  4. County Durham DL14 6AD, UK

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Editor,—van der Hulst and colleagues (Gut 1998;42:166–9) suggest that apparent metronidazole resistance predicts response to anti-helicobacter therapy regimens containing this antibiotic. However, the cure rate with their regimen of omeprazole, bismuth, tetracycline, and metronidazole for one week was only 90% (74/82). This is different from previous reports of this regimen given for seven or 12 days when 97 to 98% eradication rates were reported, and clearly antibiotic resistance was not a factor.1-3

Perhaps the answer lies in the technique used …

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