One-day Quadruple Therapy Compared With 7-day Triple Therapy For Helicobacter Pylori Infection
Creator
Lara L F; Cisneros G; Gurney M; Van Ness M; Jarjoura D; Moauro B; Polen A; Rutecki G; Whittier F
Publisher
Archives of Internal Medicine
Date
2003
2003-09
Description
Background: Eradication of Helicobacter pylori infection has had an impact on the treatment and recurrence rates of peptic ulcer disease and malignancies such as mucosa-associated lymphoid tissue lymphoma. Treatment options are cumbersome, expensive, and associated with side effects. Methods: Randomized, prospective, open-labeled equivalence trial with a parallel-group design to compare eradication rates of H pylori with a 1-day, 4-drug regimen with a 7-day, 3-drug regimen. A total of 160 patients with dyspepsia and a Glasgow Dyspepsia Severity Score of at least 3 had a urea breath test labeled with carbon 14. Patients who tested positive were randomized to 1 of the 2 study groups. The study was designed to test the therapeutic equivalence of 1-day and 7-day regimens based on the percentage of H pylori eradication in each group at 5 weeks. Results: The 1-day treatment group (n = 80) had a slightly higher eradication percentage (95%) than the 7-day group (90%). The possible inferiority of the 1-day treatment relative to the 7-day treatment, a 15% difference in the number of patients whose infection was not eradicated at 5 weeks, was rejected (P < .001; 90% confidence interval, 2.7%-11%). Both groups demonstrated a mean decrease of 7.5 points in the Glasgow Dyspepsia Severity Score. The 2 groups showed no significant differences in side effects. Patients whose treatment failed (4 in the 1-day treatment group and 7 in the 7-day treatment group) were retreated for 10 days. One patient from the 7-day treatment group still tested positive after the second treatment. Conclusions: The 1-day treatment proved to be statistically similar to the 7-day treatment for the eradication of H pylori in patients with dyspepsia and a positive urea breath test. Further evaluation will be necessary to determine whether the 1-day regimen is adequate for patients with peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, or gastric adenocarcinoma.
Subject
clarithromycin; cure; duodenal-ulcer disease; eradication; follow-up; General & Internal Medicine; nonulcer dyspepsia; peptic-ulcer; proton-pump inhibitor; term; united-states; urea breath test
A high index of suspicion is required for early detection of complications, most commonly diverticular abscess and colovesical fistula. Appropriate antibiotic therapy should cover a wide range of potential pathogens.
The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society
Date
1996
1996-08
Description
Although first described almost a century ago, only in the last 15 years has Helicobacter pylori been characterized and associations with disease states recognized. H pylori has been linked to both gastritis and peptic ulcer disease. There is also evidence for a relationship with non-Hodgkin's lymphoma, mucosa-associated lymphoid tissue lymphoma, and perhaps even adenocarcinoma of the stomach. There is currently insufficient evidence to link H pylori to nonulcer dyspepsia. Current recommendations are to treat all patients with gastric or duodenal ulcers who test positive for H pylori, as therapy will significantly reduce the recurrence rate of these conditions.