Comparison of omeprazole, metronidazole and clarithromycin with omeprazole/amoxicillin dual-therapy for the cure of Helicobacter pylori infection

In this randomized, multicenter trial, we evaluated the effectiveness and side effect profile of a modified omeprazole-based triple therapy to cure Helicobacter pylori infection. The control group consisted of patients treated with standard dual therapy comprising omeprazole and amoxicillin. One hundred and fifty-seven H. pylori infected patients with duodenal ulcers were randomly assigned to receive either a combination of omeprazole 10 mg, clarithromycin 250 mg and metronidazole 400 mg (OCM) given three times daily for 10 days (n = 81),or a combination of omeprazole 20 mg and amoxicillin 1 g (OA) given twice daily for 14 days (n = 76). Prior to treatment and after 2 and 6 weeks, gastric biopsies from the antrum and corpus were obtained for histology and H. pylori culture. H. pylori infection was cured in 97.4% after OCM and in 65.8% after OA in the per-protocol analysis (p < 0.001) (intention-to-treat analysis: 93.4% and 63.2%, respectively). H. pylori was successfully cultured in 122 patients (77%). The overall rate of metronidazole resistance was 19.7% (24/122), no primary resistance to clarithromycin or amoxicillin was found. In the OCM group, all patients infected with metronidazole-sensitive H. pylori strains (n = 51) and those infected with strains of unknown susceptibility to metronidazole (n = 14)were cured (100%), while 77% (10/13) of those harboring metronidazole-resistant. strains were cured of the infection (p = 0.36). Side effects leading to premature termination of treatment occurred in 2.5% of the patients in the OCM group and in 1.4 % of the OA group. We conclude that combined treatment with omeprazole, clarithromycin and a higher dose of metronidazole is highly effective in curing H, pylori infection, Helicobacter pylori omeprazole and that this regimen remains very effective in the presence of metronidazole resistant strains

Fully integrated mobility scenarios within sustainable futures for Germany

Transport has been analysed as a sector and service fully embedded in the overall economy in Germany using a validated economy-environment model (Panta Rhei). Two contrasting scenarios for potential future macro-economic policies in Germany until the year 2020 have been analysed. Both scenarios result in economic and transport volume growth. Transport volumes are strongly driven by increasing international trade and diver-sification of labour. Moderating this trend appears as a key factor to influence transport volume growth. A decoupling of carbon dioxide emissions from economic growth appears only feasible with significant efficiency gains. Current markets have no sufficient incenives to realise these gains. Current markets have no sufficient incentives to realise these gains by themselves. If price signal shall be set, a long-term doubling of fuel prices and road charges seems necessary in order to cut the fleet fuel economy by two and to in-duce higher transport productivity. Furthermore, if economic growth by transport growth as well as reductions in carbon dioxide emissions shall be achieved, then the emissions from car travel, with two thirds the biggest emitter, must - and can - reduce strongly in order to compensate for the desired growth in freight transport. Maximal half of the transport emissions can be attributed to mobility demands of the end user. In particular the diverse and growing &quot;leisure and tourism&quot; activities are very (car) transport intensive. The other half must be allocated as a transport service, among which goods transport for building and food production. Hence policies affecting (private) transport or leisure activities have stronger links, while (freight) transport is linked with a variety of other fields. Emissions from vehicle production, including all product chains, add another 50 % to the carbon dioxide balance from vehicle operation for Germany, services add another 30 %, which has rarely been established quantitatively. These sectors represent important and increasing areas for reduction measures. Total employment and gross-value added in the transport sector hinge to about half on vehicle production and services. However production shifts fo foreign countries while services increas domestically. But despite their growth most employment and value in vehicle production will be generated outside Germany

Mobilität und Verkehr

Auf der Grundlage von Leitlinien, Regeln und Indi- katoren für eine nachhaltige Mobilität werden Nachhaltigkeitsdefizite identifiziert. Drei alter- native Szenarien zeigen mögliche künftige Entwick- lungspfade bis zum Jahr 2020 auf. Sie dienen als Grundlage zur Herleitung von Maß- nahmenbündel zur Überwindung von Nachhaltigkeit- defiziten