Treating H. pylori shorter than one week--a real future perspective?
BACKGROUND
We assessed the current impact of H. pylori eradication therapies with a short (4-6 days) and very short (< or = 3 days) duration of antibiotic treatment because of possible advantages in terms of costs and side effects over standard one-week triple therapy.


METHODS
The literature was reviewed and 35 studies analyzed, leading to a total of 51 treatment regimens with 2177 patients.


RESULTS
Cumulative per-protocol H. pylori eradication rates were 61.3%, 75.2%, and 79.4% for dual, triple and quadruple therapies, respectively. Dual therapy was inferior to triple and quadruple regimens (p < 0.001), while the difference between triple and quadruple therapy did not reach statistical significance. Subgroup analysis of all triple therapies containing macrolides and imidazoles resulted in a success rate of 84.1% (vs. 62.1% for other triple therapies, p < 0.0001). Decreasing the treatment duration to 3 days or less resulted in a loss of efficacy for both bismuth-based quadruple therapy with tetracycline and imidazoles (90.3% vs. 65%, p < 0.0001) and for triple therapy with macrolides and amoxicillin (70.3% vs. 31.2%, p < 0.0001). This does not hold true for triple therapy containing imidazoles and macrolides (84.5% vs. 83.6%, not significant). Regardless of the duration of therapy quadruple regimes with macrolides/imidazoles/amoxicillin achieved an eradication rate of 91.9%.


CONCLUSIONS
Preliminary data suggest that the short-term combination of proton pump inhibitors with 2 antibiotics (macrolides and imidazoles) with/without amoxicillin may be as effective as standard one week triple therapies, even for treatment durations of 3 days or less. The combination of proton pump inhibitors with bismuth, tetracycline and imidazoles appears to be equally effective, if given for at least 4 days.
Treiber
G
G
Robert Bosch Hospital, Department of Gastroenterology, Stuttgart. gerhard.treiber@medizin.uni-magdeburg.de
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005756:Gastritis / Q000188:drug therapy*; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents