Lorenzo Fuccio, MD; Maria Eugenia Minardi, MD; Rocco Maurizio Zagari, MD; Diego Grilli, PhD; Nicola Magrini, MD; Franco Bazzoli, MD
Acknowledgments: The authors thank Dr. Catherine Henderson for editorial support.
Potential Financial Conflicts of Interest: Honoraria: F. Bazzoli (AstraZeneca, Takeda, Altana Pharma).
Requests for Single Reprints: Franco Bazzoli, MD, Dipartimento di Medicina Interna e Gastroenterologia, Università di Bologna, Policlinico S. Orsola, Via Massarenti, 9, 40138 Bologna, Italy; e-mail, email@example.com.
Current Author Addresses: Drs. Fuccio, Minardi, Zagari, and Bazzoli: Dipartimento di Medicina Interna e Gastroenterologia, Università di Bologna, Policlinico S. Orsola, Via Massarenti, 9, 40138 Bologna, Italy.
Dr. Grilli: University of South Florida, 4202 East Fowler Avenue, Tampa, FL 33620.
Dr. Magrini: Centre for the Evaluation of the Effectiveness of Health Care, Local Health Authority, Viale Muratori 201, 41100 Modena, Italy.
Proton-pump inhibitor (PPI)–based triple therapy is the recommended first-line treatment for Helicobacter pylori infection. A consensus on treatment duration is lacking.
To summarize the benefits and harms of different durations of PPI-based triple therapy.
PubMed, EMBASE, the Cochrane Library, and proceedings of major meetings through May 2007.
English-language reports of randomized, controlled trials that compared duration (7, 10, or 14 days) of triple therapy and in which adequate testing confirmed the initial H. pylori infection and its eradication.
Two authors independently extracted data on study design, treatment, number of patients enrolled and number of patients with successful eradication, disease at enrollment, testing, adverse effects, year of publication, publication format, and country.
Of 21 included studies, 11 compared 7-day therapy with 10-day therapy, and 13 compared 7-day therapy with 14-day therapy. Meta-analysis yielded relative risks (RRs) for eradication of 1.05 (95% CI, 1.01 to 1.10) for 7-day compared with 10-day amoxicillin-containing triple therapy (10 studies) and 1.07 (CI, 1.02 to 1.12) for 7-day compared with 14-day therapy (11 studies). Meta-analysis of the 3 studies that compared 7-day with 14-day metronidazole-containing therapy yielded an RR of 1.08 (CI, 0.96 to 1.22). The 7-day versus 10-day comparisons yielded RRs of 1.03 (CI, 0.97 to 1.10) for peptic ulcer disease and 1.10 (CI, 1.02 to 1.20) for nonulcer dyspepsia. For the 7-day versus 14-day comparisons, the RRs were 1.04 (CI, 0.99 to 1.09) and 1.03 (CI, 0.88 to 1.20), respectively. The RRs for frequency of adverse events were 0.98 (CI, 0.85 to 1.14) and 1.08 (CI, 0.84 to 1.40) for 7-day therapy compared with 10- and 14-day therapy, respectively. Diarrhea and taste disturbance were the most frequently reported adverse events (5%).
Subgroup analyses were limited by the few studies evaluating different drug regimens and disease at enrollment. Seventeen of the included studies had poor methodological quality or inadequate reporting.
Available data suggest that extending triple therapy beyond 7 days is unlikely to be a clinically useful strategy.
Lorenzo Fuccio, Maria Eugenia Minardi, Rocco Maurizio Zagari, Diego Grilli, Nicola Magrini, Franco Bazzoli. Meta-analysis: Duration of First-Line Proton-Pump Inhibitor–Based Triple Therapy for Helicobacter pylori Eradication. Ann Intern Med. 2007;147:553–562. doi: 10.7326/0003-4819-147-8-200710160-00008
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Published: Ann Intern Med. 2007;147(8):553-562.
Gastroenterology/Hepatology, H. Pylori, Infectious Disease, Peptic Disease.
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