H. pylori: a 5-day quadruple therapy course led to higher cure rates but more diarrhoea than a 7-day triple therapy course

Clinical bottom line (level 1b)

Patients with H. pylori infection who received a 5-day quadruple therapy eradication course compared with a 7-day triple therapy course were more likely to be cured (NNT = 9 at 4 weeks) , but more likely to develop diarrhoea too (NNH = 5 at 4 years) .

Nagahara et al: Aliment Pharmacol Ther 2001; 15 : 417-421

Expires May 2004

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: gastroenterology clinic, university hospital, Japan

160 patients (aged 17 to 73; mean 50, 74% male) with dyspepsia or peptic ulcers and H. pylori infection

Excluded if

allergy to study drugs
previous course of H. pylori eradication therapy
malignancy, hepatic or renal failure
pregnancy
partial or total gastrectomy

Control Group: (n = 80, 80 analysed): rabeprazole 20 mg twice daily, amoxicillin 750 mg twice daily, and clarithromycin 200 mg twice daily for 7 days
Experimental Group: (n = 80, 80 analysed): rabeprazole 20 mg twice daily, amoxicillin 750 mg twice daily, clarithromycin 200 mg twice daily, and metronidazole 250 mg twice daily for 5 days

98% followed for 4 weeks

The evidence

Outcome	Time to outcome	CER	EER	RRR (95% CI)	ARR (95% CI)	NNT (95% CI)
cured	4 weeks	65 (81.3%)	74 (92.5%)	14% (1% to 29%)	11.3% (0.932% to 21.6%)	9 (5 to 110)
diarrhoea or soft stool	4 weeks	6 (7.50%)	2 (26.3%)	-250% (-720% to -49%)	-18.8% (-30.0% to -7.51%)	-5 (-13 to -3)

Citation

Nagahara A, Miwa H, Yamada T, et al: five-day proton-pump inhibitor-based quadruple therapy regimen is more effective than 7-day triple therapy regimen for Helicobacter pylori infection. Aliment Pharmacol Ther 2001; 15 : 417-421

Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, May 2002
Reviewer:

_{Clinical Question.}

_Patient	_{H. pylori infection}
_{Intervention or Exposure}	_{quadruple therapy}
_Comparison	_{triple therapy}
_Outcome	_{cure, diarrhoea}