How can the current strategies for Helicobacter pylori eradication therapy be improved?
BACKGROUND
The use of Helicobacter pylori eradication therapy is advocated in an increasing variety of situations. It is therefore important to optimise current strategies to eradicate H pylori infection.


OBJECTIVE
To define the optimum dosage, drugs and duration of proton pump inhibitor (PPI) triple therapy.


METHODS
A review of the literature was performed to identify randomized controlled trials and systematic reviews addressing these issues.


RESULTS
In PPI, amoxicillin and clarithromycin (PAC) based regimens, twice daily PPI gave optimal eradication rates (relative risk reduction [RRR] compared with once daily = 7%; 95% CI 2% to 12%), but in PPI, clarithromycin and metronidazole (PCM) based regimens there was no difference (RRR = 2%; 95% CI -7% to 10%). Omeprazole and lansoprazole-containing triple therapies achieved similar eradication rates, but rabeprazole appeared superior to omeprazole (RRR = 8%; 95% CI 2% to 14%). The optimum clarithromycin dose in a PAC regimen was 500 mg twice daily (RRR = 11%; 95% CI = 3% to 18%), but 250mg twice daily in a PCM regimen (RRR = 2%; 95% CI -4% to 7%). Eradication rates were lower with a seven day regimen compared with fourteen (RRR = 12%; 95% CI 7% to 17%). Overall there was no difference between a PAC and a PCM regimen (RRR = 0%; 95% CI -3% to 3%).


CONCLUSIONS
PAC and PCM regimens are equally effective if used optimally, though PCM is cheaper. The eradication regimen and its duration should be tailored according to the clinical situation.
Ford
Alex
A
Gastroenterology Unit, City Hospital National Health Service Trust, Dudley Road, Winston Green, Birmingham B18 7QH, United Kingdom.
Moayyedi
Paul
P
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D064747:Lansoprazole; D009853:Omeprazole / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D013997:Time Factors
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D000658:Amoxicillin; D017291:Clarithromycin; D009853:Omeprazole