Treatment of Helicobacter pylori in surgical practice: A randomised trial of triple versus quadruple therapy in a rural district general hospital

Abstract

AIM:To compare a lansoprazole-based triple versus quadruple therapy for Helicobacter pylori (H pylori) eradication with emphasis on side effect profile, patient compliance and eradication rate at a rural district general hospital in Wales, United Kingdom. C urea breath test 2 mo after treatment. RESULTS: Seven patients were withdrawn after randomisation. Fifty patients were assigned to LAC group and 44 to LMBT group. The intention-to-treat cure rates were 92% and 91%, whereas the perprotocol cure rates were 92% and 97%, respectively. Side effects were common, with 56% experiencing moderate to severe symptoms in the LAC group and 59% in the LMBT group. Symptoms of vomiting, diarrhoea and black stools were significantly more common in the LMBT group. Patient compliance was 100% for triple therapy and 86% for quadruple therapy (P < 0.01). One-third of patients in both groups were still taking acid-reducing medications at six-month follow-up. CONCLUSION: One-week triple and quadruple therapies have similar intention-to-treat eradication rates. Certain side effects are more common with quadruple therapy, which can compromise patient compliance. Patient education or modifications to the regimen are alternative options to improve compliance of the quadruple regimen. METHODS:

Tratamiento ideal del Helicobacter pylori: una revisión sistemática

“…Sin embargo, en otros países, como Brasil y Reino Unido, las tasas de erradicación fueron superiores 19,51 , siendo estos resultados similares a los obtenidos en países con bajas tasas de resistencia a claritromicina (menor del 15 al 20%). Adicionalmente, con terapias mayores a 7 días de duración no se encontró mayor eficacia de erradicación, como en los casos de Estados Unidos, Colombia y Chile 24,41,42 .…”

“…Las tasas de erradicación en análisis por ITT de la triple terapia estándar versus la cuádruple terapia con bismuto de 7 días de duración en el Reino Unido fueron del 92 y del 91%, respectivamente, y en Estados Unidos, con 10 días de duración por ITT, del 83.2 y del 87.7 19,20 . Adicionalmente, en Grecia, con 10 días de duración, el porcentaje de erradicación por ITT para la triple terapia fue del 78%, y para la terapia cuádruple, del 65% 21 .…”

Moxifloxacin-Based Triple Therapy Versus Clarithromycin-Based Triple Therapy for First-Line Treatment of Helicobacter pylori Infection: A Meta-Analysis of Randomized Controlled Trials

“…The sensitivity analysis showed that both the eradication rate and the inci- T a b l e 1 . Ch a r a c t e r i s t i c s o f I n c l u d e d S t u d i e s ( 2 1 , 2 7 , 2 9 , 3 5 (36)(37)(38). Related to these drawbacks, more effective, simpler, and better tolerated regimens Nista (27) Bago (21) Liu (29) Kilic (35) 48.9%…”

Meta-Analysis of Bismuth Quadruple Therapy versus Clarithromycin Triple Therapy for Empiric Primary Treatment of Helicobacter pylori Infection

“…After detailed review of selected articles, 12 RCTs [8,9,10,11,12,13,14,15,16,17,18,19] with 2,753 patients fulfilled the inclusion criteria of the meta-analysis (fig. 1).…”