7 days of triple therapy good for H pylori

Journal of Family Practice, Jan, 2008

* Clinical question

What is the optimum duration of treatment for Helicobacter pylori eradication?

* Bottom line

Seven days of treatment with triple therapy--a proton pump inhibitor (PPI) plus clarithromycin (Biaxin) plus amoxicillin or metronidazole--produces rates of eradication that are nearly as good as 10 to 14 days of treatment. Results are equally good if only high-quality research is considered.

Level of evidence

1a--: Systematic review of level 1 diagnostic studies displaying worrisome heterogeneity

Study design

Meta-analysis (randomized controlled trials)

Funding

Self-funded or unfunded

Setting

Various (meta-analysis)

Synopsis

Researchers conducting this meta-analysis looked through 3 databases to find research comparing different durations of triple therapy for H pylori eradication. They also searched conference proceedings, but limited their choices to articles in English. Two researchers independently abstracted the data and assessed study quality via the commonly used Jadad criteria.

Their search yielded 21 studies comparing 7, 10, and 14 days of treatment using regimens of a PPI with clarithromycin and either amoxicillin or metronidazole. Most of the studies evaluated patients with peptic ulcer disease (n=15). Only 4 of the studies had a quality score of 4 or 5 of a possible 5. Just 3 studies clearly described concealed allocation, and only 4 studies were double-blinded.

Outcomes for 7-day therapy were similar to longer courses. The 11 studies comparing 7 days with 10 days of treatment collectively showed a slightly higher cure rate with 10 days of therapy, though the difference is not likely to be clinically relevant (77% vs 81% cure; relative risk [RR]=1.05). Differences between 7 days and 14 days of treatment were similar in 13 studies: 73% vs 78%; RR=1.07.

The outcomes were not different based on duration of therapy when only the high-quality studies were analyzed.

Study limitations. The researchers found heterogeneity among the study results that could be explained by the use of antibiotic. The difference in outcomes between durations of therapy were present in studies using amoxicillin but not in studies using metronidazole.

Fuccio L, Minardi ME, Zagari RM, Grilli D, Magrini N, Bazzoli E Meta-analysis: Duration of first-line proton-pump inhibitor-based triple therapy for Helicobacter pylori eradication. Ann Intern Med 2007; 147:553-562.