Is 1 week of treatment sufficient to eradicate Helicobacter pylori?

One week of omeprazole, amoxicillin, and clarithromyin given twice daily is as effective at eradicating Helicobacter pylori (HP) as 2 weeks of treatment. It also costs less and is less burdensome for patients. (LOE = 1b)

Zagari RM, Bianchi-Porro G, Fiocca R, Gasbarrini G, Roda E, Bazzoli F. Comparison of 1 and 2 weeks of omeprazole, amoxicillin and clarithromycin treatment for Helicobacter pylori eradication: the HYPER study. Gut 2007;56:475-479.  [PMID:17028126]

Randomized controlled trial (double-blinded)

Industry

Concealed

Outpatient (specialty)

A variety of regimens of varying durations are used to eradicate HP, from as short as 1 day to as long as 14 days. One of the most widely used regimens uses omeprazole 20 mg, amoxicillin 1 g, and clarithromycin 500 mg each (OAC) twice daily. It is usually given for 7 days in Europe but most American physicians prescribe it for 10 to 14 days (the similar and widely used PrevPac is also labeled for 14 days). Meta-analyses have found higher eradication rates with a longer duration of therapy, but only a few studies have directly compared these 2 durations of therapy. In this study, 909 adults (mean age = 46 years; 68% were male) with a symptomatic duodenal ulcer and positive rapid urease test for HP were randomized to receive OAC for 1 week, OAC for 2 weeks, or omeprazole and amoxicillin alone. They were endoscoped at the end of the 2-week treatment period to assess healing. If the ulcer was not healed, they underwent endoscopy again at 4 weeks. All patients with a healed ulcer underwent yet another endoscopy at least 4 weeks after the end of treatment to confirm eradication, and also had urea breath testing at that time. HP was considered eradicated if both biopsy specimens and the urea breath test were all negative. Groups were similar at baseline and analysis was by intention to treat. A similar number of patients in each group (17 - 23) were lost to follow-up. The HP eradication rate was similar for the 1- and 2-week groups (79.7% vs 81.7%); both OAC groups had a higher eradication rate than the omeprazole and amoxicillin alone group (44.6%). Adverse events and discontinuation of treatment were similar between the 1- and 2-week groups.