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Quadruple therapy appears effective for eliminating H. pylori
Malfertheiner P. Lancet. 2011;doi:10.1016/S0140-6736(11)60020-2.
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Ten days of quadruple therapy with omeprazole plus a single three-in-one capsule containing bismuth subcitrate potassium, metronidazole and tetracycline may be a better option than the standard 7-day treatment regimen of omeprazole, amoxicillin and clarithromycin in adults with Helicobacter pylori infection.
Peter Malfertheiner, PhD, Otto-von-Guericke-Universität, Magdeburg, Germany, and colleagues randomly assigned 218 patients to the 10-day therapy and 222 patients to the 7-day therapy. The researchers measured primary outcome of H. pylori eradication through two negative 13C-urea breath tests at a minimum of 28 and 56 days after the end of treatment.
The researchers found that, in the worst-case scenario, eradication rates were 80% in the quadruple-therapy group compared with 55% in the standard-therapy group. Safety profiles for both treatments were similar. Main adverse events included gastrointestinal and central nervous system disorders.
They said their study findings support the use of quadruple therapy, particularly in areas with high levels of clarithromycin resistance, noting that failure rates in about 40% of patients have been reported and continue to increase in Europe as resistance rates rise.
“Clarithromycin-resistant H. pylori continues to increase in prevalence, and although rates of metronidazole resistance are also high, the results from our study showed that clarithromycin resistance reduces the efficacy of standard therapy, whereas resistance to metronidazole has a slight effect on the efficacy of quadruple therapy,” the researchers wrote.
Possible limitations of the study included some variation in duration of treatment in each group and their choice of metronidazole-resistance test. However, the researchers noted that the test findings were consistent with other studies.
“When the four highest-quality trials from this analysis were considered, prolonging treatment with standard therapy beyond 7 days (with extension up to 10 days) was not associated with additional benefit,” the researchers said.
In an accompanying editorial, Byoung Hwan Lee, MD, and Nayoung Kim, MD, of the Seoul National University College of Medicine, South Korea, concluded, “Further prospective study is necessary to compare bismuth-containing quadruple therapy with the non-bismuth modalities as first-line therapy, not only for eradication rate but also for compliance and side effects, to establish the most efficient modality to eradicate H. pylori.”
Disclosure: Axcan Pharma Inc., provided funding for the study.
Effective therapies for H. pylori infection are badly needed. The study appears promising, but more study is needed. Development of resistance and presence of mulltiple strains in gastric infection complicate treatment.
–Herbert DuPont, MD
Infectious Disease News Editorial Board member
Diclosure: Dr. DuPont reports no relevant financial disclosures.
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