One-Day Quadruple Therapy Compared with 7-Day Triple Therapy for H pylori Infection

Abstract & Commentary

Synopsis: One-day quadruple therapy for eradication of H pylori seems effective.

Source: Lara L, et al. Arch Intern Med. 2003;163(17):2079-2084.

In this study from Lara and associates, 160 patients with dyspepsia and Helicobacter pylori infection were identified by a positive 14C urea breath test. Comparators were a 1-day treatment regimen of 2 tablets of 262 mg bismuth subsalicylate q.i.d., one 500-mg metronidazole tablet q.i.d., 2 grams of amoxicillin suspension q.i.d., and 2 capsules of 30-mg lansoprazole once daily vs a regimen of 7 days of clarithromycin 500 mg b.i.d., 1 gram of amoxicillin b.i.d., and lansoprazole 30 mg b.i.d. The 1-day therapy eradicated 95% of H pylori vs 90% with the 7-day treatment program. Adverse events were comparable, and no patient was non-compliant.

Comment by Malcolm Robinson, MD, FACP, FACG

It is widely accepted that eradication of H pylori is effective in preventing the recurrence of many gastric and duodenal ulcers, although other benefits of eradication are more controversial. In particular, data in North America don’t currently support H pylori eradication for the treatment of dyspepsia. However, it is known that eradication in ulcer disease patients positive for H pylori parallels that seen in patients who present with dyspepsia.

In this study, eradication rates with both tested regimens were quite high. As Lara et al point out, shorter therapies that achieve successful eradication rates would improve compliance. Previous studies have suggested less robust results for 1-day therapy than seen in the present study. As might have been expected, neither the 1-day regimen nor the 7-day program eliminated dyspepsia symptoms though declines in symptom severity were seen. Further verification of the applicability of ultra-short H pylori eradication regimens would be most welcome.

Dr. Robinson, Medical Director, Oklahoma Foundation for Digestive Research; Clinical Professor of Medicine, University of Oklahoma College of Medicine, Oklahoma City, OK, is Associate Editor of Internal Medicine Alert.

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