Three‐day lansoprazole quadruple therapy for Helicobacter pylori‐positive duodenal ulcers: a randomized controlled study

Abstract

Aim: To compare the efficacy and tolerability of a 3‐day quadruple therapy with a standard 7‐day triple therapy in eradicating Helicobacter pylori infection and healing duodenal ulcers. Methods: Patients with H. pylori‐positive duodenal ulcers were randomized to receive either lansoprazole 30 mg, clarithromycin 500 mg, and metronidazole 400 mg twice daily for 7 days (LCM‐7) or lansoprazole 30 mg, clarithromycin 500 mg, metronidazole 400 mg, and bismuth subcitrate 240 mg twice daily for 3 days (LCMB‐3). No pre‐ or post‐treatment acid suppression was used. Follow‐up endoscopy was performed at week 6. Results: A total of 118 patients were recruited. Sixty patients in the LCM‐7 group and 53 patients in the LCMB‐3 group returned for endoscopy. Intention‐to‐treat eradication rates were 87% and 86% (P=0.94) and per protocol eradication rates were 87% and 94% (P=0.29) in the LCM‐7 and LCMB‐3 groups, respectively. Per protocol and intention‐to‐treat ulcer healing rates were 98% and 98% in LCM‐7 and 100% and 91% in LCMB‐3, respectively. There were no significant differences in efficacy in relation to the initial metronidazole and clarithromycin susceptibility. Significant reduction in the duration of side‐effects was found in the LCMB‐3 group. Conclusion: The 3‐day quadruple therapy is highly effective, better tolerated and can be considered as a first‐line therapy in duodenal ulcer management.

Triple vs. quadruple therapy for treating Helicobacter pylori infection: an updated meta‐analysis

“…Eight were excluded from further analysis; [34][35][36][37][38][39][40][41] the reasons for exclusion are outlined in Table 1. All studies compared triple vs. quadruple therapy for H. pylori eradication.…”

Is short-term therapy really sufficient to eradicate Helicobacter pylori infection?

“…Controversy surrounds the optimal composition, dosage, and duration of therapies for more acceptable, rapid, and cost-effective eradication of H. pylori infection (Chu et al, 1998). Thus, consideration has been given to the possibility of shortening the treatment time without compromising its eradication efficacy of H. pylori infection, and in some instances (Wong et al, 2001b;Gambaro et al, 2003;Lara et al, 2003;Yang et al, 2003;Giannini et al, 2006), this has achieved equivalent results to those long-term combined protocols.…”

“…One of the flaws was that few studies (Wong et al, 2001a;2001b) had focused on the impact of pre-treatment antimicrobial resistance on the outcome of the protocol, though high eradication rates were achieved even for metronidazole-or clarithromycin-resistant strains in some studies (Moshkowitz et al, 1994). It is preferable to prescribe antimicrobial agents according to the sensitivity status of the individual patient's H. pylori.…”

“…Baseline characteristics of the population among the different studies (concomitant symptoms, e.g., diameter of the ulcer, active or not, with or without bleeding; mean age; gender; body mass index; blood group; weather; drug use history; smoking and drinking habits; and antimicrobial susceptibility) (Zimmermann et al, 1992;Moshkowitz et al, 1994;Catalano et al, 1997;Misiewicz et al, 1997;Tucci et al, 1998;Ammon et al, 2000;Namiot et al, 2008) and test-and-treat strategies (the number of medications used, the dosage, frequency, duration of treatment) are also potential sources of treatment effect variation. Although logistic regression analysis demonstrated that patient's sex, age, smoking status, alcohol consumption, diagnosis (duodenal ulcer or gastritis), treatment with H2RA in the month before study entry, or the duration of the patient's disease had no significant effect on the eradication of H. pylori infection (Misiewicz et al, 1997;Wong et al, 2001b), when the set of drugs for H. pylori eradication is chosen, the above factors should all be taken into account. In addition, language barriers and resource restriction precluded review of all relevant literatures.…”

“…A significant reduction of adverse effects was observed with the use of a shorter (n=338) Excluded (n=248) because: 233 titles not appropriate; 9 articles in Spanish, German, and Japanese; 3 commences, letters; 3 studies on children Abstracts retrieved (n=90) Excluded (n=70) P<0.001), the day number with side-effects was reduced by an average of 3.5 d per patient in this study protocol in studies conducted by Wong et al (2001b). It was reported that the mean duration of all adverse effects was significantly shorter in the 3-d RAC (rabeprazole, amoxicillin, and clarithromycin) group when compared to the 7-d RAC group (2.8 d vs. 6.0 d, P<0.001) (Wong et al, 2001a).…”