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 22 February 2018

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Clinical trial: optimal H pylori eradication therapy

Research in August's American Journal of Gastroenterology shows that 7- and 10-day triple therapies of rabeprazole, clarithromycin, and amoxicillin are equally efficient in peptic ulcer patients, however, 10-day therapy is preferable in nonulcer patients.

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A 10-day triple therapy is somewhat more effective than 7-day treatment for curing Helicobacter pylori infection.

Recent studies suggest that rabeprazolea proton pump inhibitor with fast onset of acid inhibition raise the efficacy of 7-day therapies to levels obtained with a 10-day treatment.

Dr Xavier Calvet and colleagues from Spain compared the efficacy of 7- and 10-day rabeprazole-based triple therapy for H pylori eradication.

The research team randomized 458 patients to 7 or 10 days of triple therapy, including rabeprazole 20 mg, clarithromycin 500 mg, and amoxicillin 1 g, all twice a day.

Intention to treat cure rates were 74% for 7-day vs 80% for 10-day therapy
American Journal of Gastroenterology

The researchers evaluated cure rates by urea breath test.

The team gave 237 patients 7-day treatment and 221 patients received 10-day therapy.

Groups were comparable in terms of demographic variables.

The researchers found that intention to treat cure rates were 74% for 7-day and 80% for 10-day therapy.

The team noted that per-protocol cure rates were 82% and 89%, for 7-day and 10-day therapy, respectively.

Cure rates were similar in peptic ulcer patients but in subjects without ulcer they were lower for 7-day therapy at 66% vs 77% by intention to treat.

The team also observed that the cure rates in subjects without ulcer in the per-protocol analysis were 73% versus 91%.

Side effects and compliance in the 2 groups were comparable.

Dr Calvet's team concludes, “The 7- and 10-day triple therapies seem equally efficient in peptic ulcer patients.”

“In contrast, 7-day therapy is significantly less effective in nonulcer dyspepsia patients.”

“A 10-day therapy, therefore, seems preferable when treating nonulcer patients.”

Am J Gastroenterol 2005: 100(8): 1696
09 August 2005

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