Treating H. pylori shorter than one week - a real future perspective?

 

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Summary

Background: We assessed the current impact of H. pylori eradication therapies with a short (4-6 days) and very short (≤ 3 days) duration of antibiotic treatment because of possible advantages in terms of costs and side effects over standard one-week triple therapy

Methods: The literature was reviewed and 35 studies analyzed, leading to a total of 51 treatment regimens with 2177 patients.

Results: Cumulative per-protocol H. pylori eradication rates were 61.3 %, 75.2 %, and 79.4 % for dual, triple and quadruple therapies, respectively. Dual therapy was inferior to triple and quadruple regimens (p < 0.001), while the difference between triple and quadruple therapy did not reach statistical significance. Subgroup analysis of all triple therapies containing macrolides and imidazoles resulted in a success rate of 84.1 % (vs. 62.1 % for other triple therapies, p < 0.0001). Decreasing the treatment duration to 3 days or less resulted in a loss of efficacy for both bismuth-based quadruple therapy with tetracycline and imidazoles (90.3 % vs. 65 %, p < 0.0001) and for triple therapy with macrolides and amoxicillin (70.3 % vs. 31.2 %, p < 0.0001). This does not hold true for triple therapy containing imidazoles and macrolides (84.5 % vs. 83.6 %, not significant). Regardless of the duration of therapy quadruple regimes with macrolides/imidazoles/amoxicillin achieved an eradication rate of 91.9 %.

Conclusions: Preliminary data suggest that the short-term combination of proton pump inhibitors with 2 antibiotics (macrolides and imidazoles) with/without amoxicillin may be as effective as standard one week triple therapies, even for treatment durations of 3 days or less. The combination of proton pump inhibitors with bismuth, tetracyclin and imidazoles appears to be equally effective, if given for at least 4 days.

Kurzzeittherapie der H.-pylori-Infektion - eine Erfolg versprechende Perspektive?

Einleitung: Die vorliegende Literaturübersicht versucht den Stellenwert einer Kurzzeittherapie (4-6 Tage) und Ultrakurzzeittherapie (≤ 3 Tage) zur Behandlung der H.-pylori-Infektion zu beschreiben, da Vorteile im Hinblick auf Kosteneffizienz und Nebenwirkungen denkbar sind.

Methoden: Es erfolgte eine Literaturanalyse von 35 Studien, welche 51 Therapieregime mit insgesamt 2177 behandelten Patienten umfassten.

Ergebnisse: Kumulative per Protokoll H.-pylori-Eradikations­raten betrugen 61,3 %, 75,2 % und 79,4 % für eine Zweifach-, Dreifach- oder Vierfachtherapiekombination. Die Dualtherapie war allen anderen Kombinationen unterlegen (p < 0.001), wohingegen die Drei- und Vierfachkombination sich nicht signifikant voneinander unterschieden. Eine Subgruppenanalyse ergab einen Vorteil für alle Triple-Regime welche Makrolide und Imidazole enthielten (84,1 % vs. 62,1 % für alle anderen Tripletherapien, p < 0,0001). Die Verkürzung der Therapiedauer auf 3 Tage und weniger war von Nachteil für die wismuthaltige Vierfachtherapie mit Tetrazyklin und Imidazolen sowie für die Dreifachtherapie mit Makroliden und Amoxicillin (90.3 % vs. 65 % und 70,3 % vs. 31,2 %, jeweils p < 0,0001), aber statistisch bestand kein signifikanter Unterschied für eine Dreifachtherapie mit Makroliden und Imidazolen (84,5 % vs. 83,6 %). Die ­Vierfachtherapie mit Makroliden, Imidazolen und Amoxicillin erzielte unabhängig von der Therapiedauer 91,9 %.

Schlussfolgerung: Vorläufige Daten legen den Schluss nahe, dass eine Kurzzeitherapie mit Protonenpumpenhemmern und 2 Antibiotika (Makrolide und Imidazole) ± Amoxicillin ähnlich wirksam wie eine einwöchige Dreifachstandardtherapie ist. Gleiches trifft zu für eine Therapie mit Protonenpumpenhemmern, Wismut, Tetrazyklin und Imidazolen, wenn über min­destens 4 Tage behandelt wird.

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Address for correspondence

Dr. G. Treiber

University Hospital Department of Gastroenterology & Hepatology

Leipziger Straße 44

D-39120 Magdeburg

Email: gerhard.treiber@medizin.uni-magdeburg.de