Today's BMJ: How to eradicate H pylori

[FRSM]

How to eradicate H pylori
Lancet2011; doi:10.1016/S0140-6736(11)60020-2Resistance of Helicobacter pylori to clarithromycin is rising. Eradication rates of below 70% have been reported for the current gold standard—triple treatment with a proton-pump inhibitor, clarithromycin, and amoxicillin over seven days. A non-inferiority phase III trial tested 10 days’ treatment with omeprazole plus a cocktail of bismuth subcitrate potassium, metronidazole, and tetracycline, given in a single pill (quadruple treatment) against the triple treatment.

The trial showed non-inferiority of the quadruple treatment but was also powered to look at superiority. The intention to treat analysis found that H pylori was eradicated in 174 (80%) of the 218 participants randomised to receive quadruple treatment and in 123 (55%) of the 222 randomised to triple treatment. The study was conducted at 39 sites across Europe.

Both treatments had similar safety profiles, which contradicts previous studies in which quadruple treatment was given in separate pills. The accompanying editorial (doi:10.1016/S0140-6736(11)60168-2) expresses intrigue with this result, but also says that further studies are needed to compare bismuth-containing quadruple treatment with non-bismuth drug combinations, not only for eradication rate but also for compliance and side effects, to establish the best way of eradicating H pylori.