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Clinical question
Is a 1-day treatment of Helicobacter pylori as effective as a 7-day regimen
in patients with dyspepsia?
Bottom line
A 4-drug, single day treatment was as effective as 7 days of treatment with
3 drugs in eradicating Helicobacter pylori and symptoms in patients with
H.pylori-positive dyspepsia. (LOE = 1b)
Reference
Lara LF, Cisneros G, Gurney M, et al. One-day quadruple therapy compared
with 7-day triple therapy for Helicobacter pylori infection. Arch Intern Med
2003; 163:2079-84.
Study design: Randomized controlled trial (nonblinded)
Setting: Outpatient (any)
Synopsis
The researchers recruited 160 adult patients with dyspepsia scoring 3 or
higher (of a possible 20) on the Glasgow Dyspepsia Severity Score (GDSS) and
had a postive urea breath test, signifying the presence of H. pylori.
Patients were randomized to receive either a 4-drug cocktail for 1 day or
treatment with 3 drugs for 7 days. Allocation may not have been concealed
from the enrolling researcher (patients randomized to receive the 7-day
treatment were an average 7 years older than the other patients and less
likely to smoke). The 1-day regimen consisted of 2 tablets of 262 mg bismuth
subsalicylate (Pepto-Bismol), 500 mg metronidazole (Flagyl), and 2 g
amoxicillin (suspension), all taken 4 times over the course of the day,
along with 60 mg lansoprazole (Prevacid) taken once. The control group took
500 mg clarithromycin (Biaxin), 1 g amoxicillin, and 30 mg lansoprazole
twice daily for 7 days. The urea breath test was readministered 5 weeks
after the start of treatment to the 150 patients who returned. Eradication
rates were similar in the 2 groups: 95% in the 1-day group and 90% in the
7-day group. Treatment success rates were also similar between the 2 groups:
The GDSS scores dropped an average of 7.5 points in both groups (from a
baseline of 7 to 11). Side effects were tallied at the 5-week follow-up
rather than during or immediately after treatment and may not be
particularly accurate.
View Pubmed Abstract
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