Quadruple therapy backed for H pylori infections

GI infections should be attacked first-line with quadruple antibiotic therapy, a group of researchers from across Europe has concluded.

Treatment of Helicobacter pylori infection with four drugs was compared with standard triple therapy by a team led by Professor Peter Malfertheiner from the Otto von Guericke University in Magdeburg, Germany.

The researchers said that treatment failures occur in about 40 per cent of patients given standard triple therapy and that such failures have been increasing in recent years.

Such treatment failures are principally due to rising antibiotic resistance and are the main reason that H pylori infections have not been eradicated, they said.

Professor Malfertheiner and his team randomised 779 adults with recorded H pylori infection to receive either quadruple therapy or standard triple therapy.

Those assigned to quadruple therapy received 10 days' treatment with omeprazole plus a single three-in-one capsule containing bismuth subcitrate potassium, metronidazole and tetracycline.

Patients assigned to standard therapy were given seven days' treatment with omeprazole, amoxicillin and clarithromycin.

Researchers found that H pylori infections were eradicated in 80 per cent of patients given quadruple therapy, compared with 55 per cent of those given triple therapy.

Safety profiles for both treatments were similar, with adverse events mainly affecting the CNS and GI tract.

The researchers said their findings supported a change in how patients with H pylori infection should be treated.

'Quadruple therapy should be considered for first-line treatment in view of the rising prevalence of clarithromycin-resistant H pylori, especially since quadruple therapy provides superior eradication with similar safety and tolerability to standard therapy,' they concluded.

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Lancet Online 2011

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