441 Fourteen days is ideal treatment duration for Helicobacter pylori eradication

October 29, 2014

written by Brian R McAvoy.

Clinical question
What is the optimal duration of treatment for eradicating Helicobacter pylori infection?

Bottom line
For proton pump inhibitor (PPI)+clarithromycin+amoxicillin (PCA), prolonging treatment duration from 7 to 10 days, or from 10 to 14 days, is associated with a significantly higher eradication rate. The optimal duration of therapy for PCA and PPI+amoxicillin+nitroimidazole (PAN) is at least 14 days. More data are needed to confirm if there is any benefit of increasing the duration of therapy for PPI+clarithromycin+nitroimidazole (PCN) therapy.

Overall, the quality of evidence for the outcome of H. pylori persistence for PPI triple therapy was moderate because of study limitations (risk of bias). For certain subgroups, the quality of the evidence for the outcome H. pylori persistence was low (eg, PCN 14 days versus 7 days) or very low (eg, PCN 10 days versus 7 days) because of study limitations.

A PPI plus 2 antibiotics is the most commonly used first treatment to eradicate H. pylori infection. The ideal duration of therapy for H. pylori eradication is controversial, with recommendations ranging from 7 to 14 days.

Cochrane Systematic Review
Yuan Y et al. Optimum duration of regimens for Helicobacter pylori eradication. Cochrane Reviews, 2013, Issue 12. Current Art. No.: CD008337.DOI: 10.1002/14651858. CD008337.pub2. This review contains 75 studies involving 19,415 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.