Abstract
Empiric clarithromycin-containing triple therapies for eradication of Helicobacter pylori do not reliably produce a ≥80% success rate on an intention-to-treat basis. This lack of adequate treatment response is primarily because of clarithromycin resistance. This commentary discusses the findings of a meta-analysis by Villoria et al. that investigated whether a triple therapy containing a high-dose PPI and clarithromycin plus either amoxicillin or tinidazole improves the success rate of H. pylori eradication compared with a triple therapy that contains a standard-dose PPI. The mean intention-to-treat cure rates were greater in patients who used the high-dose PPI regimen compared with the standard-dose regimen (82% vs 74%, respectively). However, the actual cure rates of these studies were poor and the improvements were unlikely to be clinically significant. The prevalence of clarithromycin resistance in most of the world is such that clarithromycin-containing triple therapy should not be used empirically. Alternatives include sequential or concomitant therapy and bismuth-containing quadruple therapies.
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References
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Acknowledgements
This material is based upon work supported in part by the Office of Research and Development Medical Research Service Department of Veterans Affairs and by Public Health Service grant DK56338, which funds the Texas Medical Center Digestive Diseases Center. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the VA or NIH.
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DY Graham has received grant support and/or pharmaceutical samples from Meretek and BioHit, is a consultant for Novartis and Otsuka Pharmaceuticals and receives royalties from a Baylor College of Medicine patent. Dr Sugimoto declared no competing interests.
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Sugimoto, M., Graham, D. High-dose versus standard-dose PPI in triple therapy for Helicobacter pylori eradication. Nat Rev Gastroenterol Hepatol 6, 138–139 (2009). https://doi.org/10.1038/ncpgasthep1353
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DOI: https://doi.org/10.1038/ncpgasthep1353
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