M1139 Sitafloxacin-Based Third-Line Eradication of H. pylori

Abstract

Introduction Helicobacter pylori (H. pylori) infection has been associated with different disease entities such as peptic ulcer disease, non-ulcer dyspepsia and gastric cancer. Different treatment strategies have been investigated and triple therapy using proton pump inhibitor, clarithromycin and amoxicillin or an imidazole have been widely accepted. However, optimal treatment duration remains to be settled. Objectives To determine if a longer duration (10 or 14 days) of Proton pump based triple therapy is more effective and safe compared to shorter (7days) treatment duration in terms of H. pylori eradication. Methods A systematic literature search was carried out in the following databases: Pubmed, The Cochrane Library, the Health Research and Development Network, and EMBASE through January 2009. Abstracts presented from 1995 to 2007 at the United European Gastroenterology Week and Digestive Disease Week was also reviewed. In addition, manual search from the references of the papers retrieved was also conducted. Language restrictions were not applied. After critical appraisal of included studies was done, a random effects model using relative risk was used to synthesize the results (Revman 4.2) Results 26 studies were included, 17 compared 7 versus 14 day therapy, 12 studies compared 7versus 10-day therapy. Our review showed a statistically significant improvement with H. pylori eradication with the use of 14 days of treatment compared to 7-days (RR 0.79, 95% CI 0.71-0.89, p <0.0001). A similar benefit was seen with 10 days of treatment compared to 7 days (RR 0.84, 95% CI 0.730.96, p 0.01) when all studies are considered. Occurrence of adverse events was not increased with a longer treatment duration (14 vs 7days: RR 1.01 95% CI 0.84, 1.22, p 0.92; 10 vs 7 days: RR 1.04, 95% CI 0.91-1.20, p 0.53). Conclusion The overall trend shows that longer treatment duration is more favorable in terms of H. pylori eradication and that no significant increase in adverse events is noted. However, cost-effectiveness studies may need to be performed and that drug resistance should be considered and tested in areas with high prevalence of drug resistance to the first line H. pylori treatment regimen.