We read with interest the recent paper comparing 1 and 2 weeks of triple therapy for Helicobacter pylori infection in patients with duodenal ulcer disease. (Gut 2007;56:475–9) H pylori is an infectious disease and the goal of treatment is to cure the infection. In 2007, one would hope to be able to reliably cure ⩾95% of the treated patients (discussed by Graham et al).¹ In 1989, a successful treatment has been defined as one that cures >80% of the patients.² By 1995, it seemed that 90% was achievable.³ The Maastricht consensus conferences defined a useful therapy as the one with an intention to treat (ITT) cure rate of >80%, which is a relatively low hurdle (ie, those with cure rates of ⩽80% would be unacceptable).⁵ Although the authors concluded that 7 and 14 days therapy provided essentially equivalent results, the focus should have been on the fact that the cure rates obtained were unacceptably low with either duration (eg, ITT of 79.7 for 7 days and 81.7 for 14 days), especially among patients with duodenal ulcer disease where the cure rates are typically higher than among patients without ulcers.^5–8

Their results are not unexpected as large studies of this legacy triple therapy (proton-pump inhibitor (PPI), amoxicillin and clarithromycin) have recently yielded unacceptably low eradication rates in Europe and the US, and have only infrequently achieved the minimum 80% success rate (table 1).^10–17 Overall, these results suggest that traditional triple therapy should no longer be used in Western populations unless pretreatment susceptibility is …