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Can 2-week H pylori regimen be cut to 1 week?

* Clinical question

Is 1 week of treatment sufficient to eradicate Helicobacter pylori?

* Bottom line

Yes, 1 week of omeprazole, amoxicillin, and clarithromycin taken twice daily is as effective at eradicating H pylori as 2 weeks of treatment. It also costs less and is less burdensome for patients.

Level of evidence

1b: individual randomized controlled trial (with narrow confidence interval)

Study design

Randomized controlled trial (double-blinded)

Funding

Industry

Allocation

Concealed

Setting

Outpatient (specialty)

Synopsis

A variety of regimens of different durations are used to eradicate H pylori, from as short as 1 day to as long as 14 days. One of the most widely used regimens involves omeprazole 20 mg, amoxicillin 1 g, and clarithromycin 500 mg each (OAC) twice daily. It is usually given for 7 days in Europe, but most American physicians prescribe it for 10 to 14 days (the similar and widely used PrevPac is also labeled for 14 days). Meta-analyses have found higher eradication rates with a longer duration of therapy, but only a few studies have directly compared these 2 durations of therapy.

In this study, 909 adults (mean age, 46 years; 68% were male) with a symptomatic duodenal ulcer and positive rapid urease test for H pylori were randomized to receive OAC for 1 week, OAC for 2 weeks, or omeprazole and amoxicillin alone. Patients received an endoscopy at the end of the 2-week treatment period to assess healing. If the ulcer was not healed, they underwent endoscopy again at 4 weeks. All patients with a healed ulcer underwent yet another endoscopy at least 4 weeks after the end of treatment to confirm eradication, and also had urea breath testing at that time. H pylori was considered eradicated if both biopsy specimens and the urea breath test were all negative. Groups were similar at baseline, and analysis was by intention to treat.

A similar number of patients in each group (17-23) were lost to follow-up. The H pylori eradication rate was similar for the 1- and 2-week groups (79.7% vs 81.7%); both OAC groups had a higher eradication rate than the groups taking omeprazole and amoxicillin alone (44.6%). Adverse events and discontinuation of treatment were similar between the 1- and 2-week groups.

FAST TRACK

The H pylori eradication rate was similar for the 1- and 2-week groups (79.7% vs 81.7%)

Zagari RM, Bianchi-Porro G, Fiocca R, Gasbarrini G, Roda E, Bazzoli F. Comparison of 1 and 2 weeks of omeprazole, amoxicillin and clarithromycin treatment for Helicobacter pylori eradication: the HYPER study. Gut 2007; 56:475-479.

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Article Details
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Title Annotation:Patient Oriented Evidence that Matters
Publication:Journal of Family Practice
Geographic Code:1USA
Date:Jun 1, 2007
Words:425
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