Duodenal ulcer: H. pylori: a 3-day quadruple therapy eradication course was as effective as a 7-day triple therapy course

Clinical bottom line (level 1b)

Patients with H. pylori-infected duodenal ulcers who received a 3-day quadruple therapy eradication course compared with a week-long triple therapy course were not less likely to have H. pylori eradication or ulcer healing.

Wong et al: Aliment Pharmacol Ther 2001; 15 : 843-849

Expires May 2004

The study

Single-blinded concealed randomised trial with intention-to-treat
Setting: 3 endoscopy units, Hong Kong

118 patients (aged 18 to 79 mean 48, 55% male) with active duodenal ulcers (5 mm or more in diameter) and H. pylori positive

Excluded if

aegd < 18, > 30
significant concomittant medical disease
received bismuth compounds and/or antibiotics and/or regular NSAIDs within last 2 weeks
active ulcer bleeding
undergone previous gastric or duodenal surgery
underlying malignancy
allergic to study drugs

Control Group: (n = 60, 60 analysed): lansoprazole 30 mg and clarithromycin 500 mg and metronidazole 400 mg twice daily for 7 days
Experimental Group: (n = 58, 58 analysed): lansoprazole 30 mg and clarithromycin 500 mg and metronidazole 500 mg plus bismuth subcitrate 240 mg, all twice daily for 3 days

100% followed for 6 weeks

The evidence

Outcome	Time to outcome	CER	EER	RRR (95% CI)	ARR (95% CI)	NNT (95% CI)
H. pylori eradication	6 weeks	52 (86.7%)	50 (86.2%)	1% (-15% to 14%)	0.46% (-11.9% to 12.8%)	220 (NNT = 8 to infinity; NNH = 8 to infinity)
healed ulcer	6 weeks	59 (98.3%)	53 (91.4%)	7% (-1% to 15%)	6.95% (-0.96% to 14.9%)	14 (NNT = 7 to infinity; NNH = 100 to infinity)

Citation

Wong WH, Wang WH, Wong WM, et al: three-day lansoprazole quadruple therapy for Helicobacter pylori-positive duodenal ulcers: a randomised controlled study. Aliment Pharmacol Ther 2001; 15 : 843-849

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

_{Clinical
Question.}

_Patient	_{H. pylori infected duodenal ulcer}
_{Intervention or Exposure}	_{quadruple therapy}
_Comparison	_{triple therapy}
_Outcome	_{H. pylori eradication, ulcer healing}