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One week of treatment for H. pylori is as good as two

Is one week of treatment sufficient to eradicate Helicobacter pylori?

Is one week of treatment sufficient to eradicate Helicobacter pylori?

Synopsis

A variety of regimens of varying durations are used to eradicate H. pylori, from as short as one day to as long as 14 days.

One of the most widely used is omeprazole 20mg, amoxicillin 1g and clarithromycin 500mg (OAC) twice daily. European physicians usually give it for seven days but most US doctors prescribe it for 10 to 14 days. The similar and widely used PrevPac is also labelled for 14 days' use.

Meta-analyses have found higher eradication rates with a longer duration of therapy, but only a few studies have directly compared these two durations of therapy. In this study, 909 adults (mean age = 46 years; 68% male) with a symptomatic duodenal ulcer and positive rapid urease test for H. pylori were randomised to receive OAC for one week, OAC for two weeks, or omeprazole and amoxicillin alone.

They were endoscoped at the end of the two-week treatment period to assess healing. If the ulcer was not healed, they had endoscopy again at four weeks. All patients with a healed ulcer had another endoscopy at least four weeks after the end of treatment to confirm eradication, and also had urea breath testing at that time. H. pylori was considered eradicated if both biopsy specimens and the urea breath test were all negative. Groups were similar at baseline, and analysis was by intention to treat. A similar number of patients in each group (17 and 23) were lost to follow-up.

The H. pylori eradication rate was similar for the one and two-week groups (79.7% and 81.7%). Both OAC groups had a higher eradication rate than the omeprazole and amoxicillin alone group (44.6%). Adverse events and discontinuation of treatment were similar between the one and two-week groups.

Level of evidence
1b (see www.infopoems.com/concept/ebm_ loe.cfm)

Study design
Randomised controlled trial (double-blind)

Funding
Industry

Allocation
Concealed

Setting
Outpatient (specialty)

Reference
Zagari RM et al. Comparison of one and two weeks of omeprazole, amoxicillin and clarithromycin treatment for Helicobacter pylori eradication: the HYPER study. Gut 2007;56:475-9.

Bottom line: One week of omeprazole, amoxicillin and clarithromyin given twice daily is as effective at eradicating H. pylori as two weeks of treatment. It also costs less and is less burdensome for patients.

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