Treating H. pylori shorter than one week--a real future perspective?

Abstract

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