What is the optimum duration of treatment for Helicobacter pylori eradication?

Seven days of treatment with triple therapy -- a proton pump inibitor (PPI) + clarithromycin (Biaxin) + amoxicillin or metronidazole -- produces rates of eradication that are nearly as good as 10 days to 14 days of treatment, and are equally good if only high-quality research is considered. (LOE = 1a-)

Fuccio L, Minardi ME, Zagari RM, Grilli D, Magrini N, Bazzoli F. Meta-analysis: Duration of first-line proton-pump inhibitor-based triple therapy for Helicobacter pylori eradication. Ann Intern Med 2007;147(8):553-562.  [PMID:17938394]

Meta-analysis (randomized controlled trials)

Self-funded or unfunded

Various (meta-analysis)

Researchers conducting this meta-analysis searched 3 databases to find research comparing different durations of triple therapy for H. pylori eradication. They also searched conference proceedings, but limited all of their choices to articles in English. Two researchers independently abstracted the data and assessed study quality via the commonly used Jadad criteria. Their search yielded 21 studies comparing 7, 10, and 14 days of treatment using regimens of a PPI with clarithromycin and amoxicillin or a PPI with clarithromycin and metronidazole. Most of the studies evaluated patients with peptic ulcer disease (n = 15). Only 4 of the studies had a quality score of 4 or 5 of a possible 5, with only 3 studies clearly described concealed allocation and only 4 studies were double blinded. The 11 studies comparing 7 days with 10 days of treatment collectively showed a slightly higher cure rate with 10 days of therapy, though the difference is not likely clinically relevant (77% vs 81% cure; relative risk = 1.05). Differences between 7 days and 14 days of treatment were similar in 13 studies: 73% versus 78%; relative risk = 1.07. There was heterogeneity among the study results that could be explained by the use of antibiotic. The difference in outcome between durations of therapy were present in studies using amoxicillin but not in studies using metronidazole. The outcomes were not different based on duration of therapy when only the high-quality studies were analyzed.