One-Day Quadruple Therapy Effective for H. pylori Infection

Laurie Barclay, MD

September 23, 2003

Sept. 23, 2003 — One-day quadruple therapy is effective for Helicobacter pylori infection, according to the results of a prospective, open-label equivalence trial published in the Sept. 22 issue of the Archives of Internal Medicine. This regimen was comparable to seven-day triple therapy in patients with dyspepsia and a positive urea breath test.

"Eradication of [ H. pylori] infection has had an impact on the treatment and recurrence rates of peptic ulcer disease and malignancies such as mucosa-associated lymphoid tissue lymphoma," write Luis F. Lara, MD, from the Wake Forest University School of Medicine in Winston-Salem, North Carolina, and colleagues. "Treatment options are cumbersome, expensive, and associated with side effects."

In this parallel-group design trial, 160 patients with dyspepsia, a Glasgow Dyspepsia Severity Score of at least 3, and a positive urea breath test were randomized to a one-day, four-drug regimen, or to a seven-day, three-drug regimen.

At five weeks, eradication percentage was 95% in the one-day treatment group and 90% in the seven-day treatment group, which was not a statistically significant difference. In both groups, mean decrease in the Glasgow Dyspepsia Severity Score was 7.5 points, and adverse events were similar.

Four patients in the one-day treatment group and seven patients in the seven-day treatment group failed treatment and were retreated for 10 days. One patient in the seven-day treatment group still tested positive for H. pylori after retreatment.

"The approach to H. pylori eradication reported in this study is cost-effective, promotes patient compliance, and could simplify the role of primary care physicians in the treatment of H. pylori infection," the authors write. "Further evaluation will be necessary to determine whether the one-day regimen is adequate for patients with peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, or gastric adenocarcinoma."

TAP Pharmaceutical Products provided some study medications. The authors report no relevant financial interests.

Arch Intern Med. 2003;163:2079-2084

Reviewed by Gary D. Vogin, MD