New short-term quadruple H. pylori eradication regimen safe and effective

NEW YORK (Reuters Health) – Compared with standard 1-week triple therapy, a new short-term quadruple regimen for eradicating Helicobacter pylori (H. pylori) appears to be cheaper but as safe and efficacious, researchers report in the Archives of Internal Medicine for January 28.

Dr. Gerhard Treiber, from the University Hospital of Magdeburg, Germany, and associates randomly assigned 243 patients with H. pylori to three treatment regimens. The first regimen consisted of 5 days of treatment with twice-daily amoxicillin 1 g, clarithromycin 250 mg and metronidazole 400 mg, plus lansoprazole 30 mg. The second regimen included ranitidine 300 mg instead of lansoprazole. The third regimen comprised a 3-day course of the three antibiotics plus lansoprazole, with 2 days of lansoprazole pretreatment.

Of the original 243 patients, 234 completed the trial. Intention-to-treat analysis showed overall eradication of H. pylori in 86.4% of the cases. Eradication rates were 89.2% with the first regimen, 88.8% with the second regimen and 81.2% with the third. These differences between the groups were not significant, Dr. Treiber's team notes.

Multiple logistic regression analysis revealed that factors associated with treatment failure included being younger than 55 years of age (p = 0.03), history of peptic ulcer (p = 0.04), smoking (p = 0.03), resistance to metronidazole (p = 0.003), low ranitidine trough serum concentrations (p = 0.005), cytotoxin-associated gene A-negative strains in peptic ulcer disease (p = 0.04) and other inflammatory protein A-positive strains (p = 0.02).

Dr. Treiber and colleagues conclude that "this short-term quadruple therapy…represents an efficacious, safe, well-tolerated, and cost-saving treatment for H. pylori eradication. Especially the 5-day regimens may be a first-line treatment option for older patients without a history of peptic ulcer."

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