الفهرس 
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Abstract
Summary
Helicobacter pylori (H. pylori) infection is considered the most prevalent bacterial infection in human beings, affecting approximately half of the world’s population. However, there are variations in its prevalence between developed and developing countries. H.pylori infection can cause various disorders including gastroduodenal and extra-gastroduodenal diseases with peptic ulcer disease and gastric cancer.
It is estimated that H. pylori prevalence in Egypt ranges from 13% to 72% in children and from 26% to 90% in adults. Diagnosis of H. pylori infection is mainly based on serology, detection of H. pylori stool antigen and histological examination of gastric tissue.
Helicobacter pylori infection has become highly resistant to traditional first-line treatment regimens because of emerging antibiotic resistance that decreased H. pylori eradication rates. So there is a considerable interest in evaluating new antibiotic combinations and regimens.
The most recommended therapy in guidelines has been standard triple therapy, consisting of a proton pump inhibitor (PPI) and two antibiotics (most commonly clarithromycin, and either amoxicillin, and/or a nitroimidazole), prescribed for 7 to 10 days. Due to increasing rates of clarithromycin resistance, triple therapy is no longer effective in many parts of the world.
Several treatment strategies have been proposed, including bismuth or nonbismuth quadruple therapies. Several studies showed that concomitant therapy, which is composed of proton pump inhibitor (PPI), amoxicillin, clarithromycin, and metronidazole or tinidazole, was more effective than triple therapy given for 7 or 10 days.
In Egypt, the preferred first-line treatment strategy for H. pylori eradication is Clarithromycin-based therapy. Furthermore, a concomitant quadruple non-Bismuth regimen or a Levofloxacin-based triple therapy is offered for the patients who are failing the first-line regimen.
NTZ was used as a mono-therapy, as it was a new drug that was unlikely to be affected by the antibiotic resistance of strains in patients who had previous failed therapies. The partial success of NTZ as a single-agent therapy would be an excellent base for further studies of combination therapy
The study is aimed to compare between the therapeutic efficacy of nitazoxanide based quadrable therapy versus clarithromycin based quadrable therapy for eradication of H.pylori infection in egyptian patients.
Our study is cohort observational cross section study conducted over 6 months period in 100 h.pylori infected patients divided into two groups (50 patients in each group) and treated by two different h.pylori eradication regimens (LOAD and concomitant regimens ) . The main results of the study revealed that:
among a number of 110 participants, a number of 9 negative cases were excluded by stools antigen test. a further one case excluded due to severe abdominal pain with. A final number of 100 case continued through the study. Fifty patients underwent concomitant regimen, and 50 patients underwent load regimen.
The mean age of enrolled participants is 35.51 ± 12.42 with a range of 49 yrs. (minimum,17 – maximum, 66). Most of them were females 72 (71%) and 29 (28%) males. Most of them were resident in a rural area 84(83.2%) and only 17 (28.7) participants were resident in urban area.
No significant association between response and mean age, gender, co-morbidities or antibiotic use. However, urban resident showed less response than rural resident p-value (0.031).
There is no significant difference between two groups regimen regarding age, sex or associated co morbidities.
There is no significant difference in the response to treatment among concomitant and load regimen p value was 0.476.
There was no significant difference among concomitant group and load group regarding abdominal pain, Nausea, and fatigue; p value was 0.451, 0.150 and 0.128 respectively.
initial load therapy have significant higher response rate than rescue load therapy ; p value = 0.050
there is no significant difference in treatment response between initial or rescue concomitant therapy (p-value 0.296)
There is significant improvement in the hemoglobin level after treatment p value 0.002.
Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion.