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 …