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Triple H pylori eradication therapy for two weeks more effective than shorter four-drug regimens

By News team

Triple-drug therapy for two weeks is more effective than shorter, four-drug regimens at treating Helicobacter pylori infection, new data suggest (Lancet online, 20 July 2011).

Contrary to previous findings in European populations (PJ, 26 February 2011, p220), the Latin-American study showed eradication of H pylori was more likely with 14 days of the standard regimen of clarithromycin, amoxicillin and a proton-pump inhibitor (lansoprazole) than with a five- or 10-day regimen that also included metronidazole (see Panel).

The authors say that geographical variations in H pylori’s resistance to antibiotics might account for some of the discrepancies between their results and those of studies carried out elsewhere. Different eradication regimens will be suitable in different regions, they suggest.

They also propose that population-wide H pylori eradication programmes based on the triple-drug regimen should be undertaken in Latin America as a means of reducing the region’s high rates of gastric cancer.

However, an accompanying comment advises against this approach, highlighting risks including anaphylactic reactions, Clostridium difficile infection and the development of antibiotic resistance.

Study details

Over 14,000 adults with Helicobacter pylori infection were randomly allocated to twice-daily treatment with either: Lansoprazole 30mg, amoxicillin 1,000mg and clarithromycin 500mg for 14 days (n=488); Lansoprazole 30mg, amoxicillin 1,000mg and clarithromycin 500mg and metronidazole 500mg for five days (n=489); or lansoprazole 30mg and amoxicillin 1,000mg for five days followed by lansoprazole 30mg, clarithromycin 500mg and metronidazole 500mg for five days (n=486).

In intention-to-treat analyses, standard triple-drug therapy was associated with an 82.2 per cent probability of H pylori eradication — 8.6 percentage points higher than the five-day quadruple-drug regimen (73.6 per cent, 95 per cent adjusted confidence interval 2.6–14.5) and 5.6 percentage points higher than the ten-day regimen (76.5 per cent, CI -0.4–11.6).

Although the 5.6 percentage point difference was not significant (P=0.04; significance at P values less than 0.025), the near significance suggests the ten-day quadruple-drug regimen is less effective than triple-drug therapy, the authors say.

Citation: The Pharmaceutical Journal URI: 11080907

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Supplementary images

  • H pylori (Medical RF.com/Science Photo Library)

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