BMJ  2004;328 (13 March), doi:10.1136/bmj.328.7440.0-f

Filler

POEM^*

One day treatment is as effective as seven to eradicate H pylori

Question Is a one day treatment of Helicobacter pylori as effective as a seven day regimen in patients with dyspepsia?

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 with a positive urea breath test (signifying the presence of H pylori). Patients were randomised to receive either a four drug cocktail for one day or treatment with three drugs for seven days. Allocation may not have been concealed from the enrolling researcher (patients randomised to receive the seven day treatment were an average seven years older than the other patients and less likely to smoke). The one day regimen consisted of two tablets of 262 mg bismuth subsalicylate (Pepto-Bismol), 500 mg metronidazole (Flagyl), and 2 g amoxicillin (suspension), all taken four 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 seven days. The urea breath test was readministered five weeks after the start of treatment to the 150 patients who returned. Eradication rates were similar in the groups: 95% in the one day group and 90% in the seven day group. Treatment success rates were also similar: the GDSS scores dropped an average of 7.5 points in both groups, from a baseline of 7-11. Side effects were tallied at the five week follow up rather than during or immediately after treatment and may not be particularly accurate.

Bottom line A four drug, single day treatment was as effective as seven days of treatment with three drugs in eradicating Helicobacter pylori and symptoms in patients with H pylori positive dyspepsia.

Level of evidence 1b (see www.infopoems.com/levels.html). Individual randomised controlled trials (with narrow confidence interval)

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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[Abstract/Free Full Text].

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^* Patient-Oriented Evidence that Matters. See editorial ( BMJ 2002;325: 983[Free Full Text])

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