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H pylori therapy better than gold standard

By Lilian Anekwe

Quadruple therapy with a proton-pump inhibitor plus a single three-in-one capsule is better than the gold-standard treatment regimen of omeprazole, amoxicillin, and clarithromycin in adults with Helicobacter pylori infection, a new trial has shown.

Researchers randomised adult patients in 39 European countries with recorded H pylori infection either a 10-day course of a new triple combination therapy of bismuth subcitrate potassium, metronidazole, and tetracycline prescribed along with omeprazole, or a seven-day course of standard therapy.

Eradication rates were evaluated by two negative 13C urea breath tests at a minimum of 28 and 56 days after the end of treatment.

In an intention-to-treat population of 440 patients, quadruple therapy had a significantly higher eradication rate, at 80%, than standard therapy, at 55%.

Severe treatment-emergent adverse events including dyspepsia, upper abdominal pain, headache and generalised infection were occurred in 5% of the quadruple therapy groups compared with 7% of the standard therapy group.

Professor Peter Malfertheiner, professor of gastroenterology and hepatology at Otto-von-Guericke University in Magdeburg, Germany, concluded: ‘Quadruple therapy should be considered for first-line treatment in view of the rising prevalence of clarithromycin-resistant H pylori, especially since it provides superior eradication with similar safety and tolerability to standard therapy.'

The Lancet, published online February 22