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HELICOBACTER PYLORI ERADICATION TRIPLE THERAPY—IS 7 DAYS LONG ENOUGH?

Fuccio L, Minardi ME, Zagari RM, . Meta-analysis: duration of first-line proton-pump inhibitor based triple therapy for Helicobacter pylori eradication. Ann Intern Med 2007;147:553–62.

It is recommended in the US and Europe recommend a proton pump inhibitor with clarithromycin and either amoxicillin or metronidazole for the first-line eradication of Helicobacter pylori. There is a transatlantic divide in the duration of treatment, with recommendations from the US being 10 days and Europe 7 days. Furthermore, previous meta-analyses have suggested there is a clinically significant increase in eradication rate if triple therapy is given for 14 days rather than 7 days. Fuccio et al report an updated meta-analysis that identified 11 eligible studies comparing 7 days with 10 days of triple therapy in 1982 patients positive for H pylori. There was a statistically significant increase in eradication rate with 10 days of treatment (relative risk (RR) 1.05; 95% CI 1.01 to 1.10). Similarly, they identified 13 trials comparing 7 days with 14 days of triple therapy in 2849 patients and found a statistically significant increase in eradication if the duration of treatment was extended (RR 1.07; 95% CI 1.03 to 1.12). The authors stated that the increase in eradication rate, while statistically significant, was of doubtful clinical significance. The European recommendation of 7 days of triple …

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