High-dose dual therapy effectiveness for Helicobacter pylori (H. pylori) rescue treatment was found to be enhanced by Metronidazole in a randomized superiority clinical study. In comparison to dual therapy in rescue treatment, researchers sought to assess the safety and effectiveness of triple therapy, which included high doses of proton pump inhibitor (PPI) and Amoxicillin + Metronidazole.

Overall, 238 subjects who had failed a minimum 2 courses of H. pylori intervention were randomized into two 14-day treatment groups consisting of either Esomeprazole 40 mg two times a day and Amoxicillin 1000 mg thrice a day plus Metronidazole 400 mg thrice a day (EAM group) or Esomeprazole 40 mg two times a day and Amoxicillin 1000 mg thrice a day (EA group). An antibiotic susceptibility test was performed utilizing the agar-dilution technique. Six weeks following the initiation of therapy, H. pylori elimination was evaluated via the 13C urea breath test.

In contrast to the EA group, the EAM group's elimination rates were considerably greater in ITT analysis and PP analysis (Table 1).

Amoxicillin and Metronidazole had resistance rates of 6.6% (13/196) and 89.8% (176/196), respectively. The elimination rates in the EAM group were unaffected by Metronidazole resistance. Comparable moderate and severe adverse effects and compliance were noted in both groups. Even in areas with a high rate of Metronidazole resistance, a triple therapy that includes large doses of PPI, and Amoxicillin with Metronidazole may be used as rescue therapy.