H. pylori: triple therapy based on antimicrobial sensitivity increased eradication rates

Clinical bottom line (level 2b)

  1. Patients with dyspepsia and an H. pylori infection who received triple therapy based on antibiotic sensitivity compared with emperic therapy were more likely to have successful eradication (NNT = 6 at 4 weeks) .
Toracchio et al: Aliment Pharmacol Ther 2000; 14 : 1639-1643
Expires January 2004

The study

Double-blinded ?concealed quasi-randomised trial with intention-to-treat
Setting: acute hospital, Italy

109 patients (aged 19 to 81; mean 54, 53% female) with dyspepsia and H. pylori infection (confirmed on antral biopsy)

Excluded if
  • chronic use of steroids or NSAIDs
  • alcohol abuse or drug addiction
  • aged < 16, > 80
  • prior eradication therapy
  • treatment with proton pump inhibitors, H-2 blockers and/or antibiotics in previous 4 weeks
  • gastrointestinal malignancy
  • severe concomitant disease
  • history of allergy to study medications
  • previous gastic surgery
  • pregnancy or lactation
  • previous H. pylori infection

Control Group: (n = 56, 52 analysed): 10 day course of triple therapy: omeprazole 20 mg twice daily, tinidazole 500 mg twice daily, clarithromycin 500 mg twice daily
Experimental Group: (n = 53, 49 analysed): antral sample tested for H.pylori antibiotic susceptibility. Tinidazole resistant cases were given amoxicillin 1 g twice daily instead.

93% followed for 4 weeks

The evidence

Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNT
(95% CI)
H. pylori eradication 4 weeks 42
(75.0%)		 48
(90.6%)		 21%
(1% to 44%)		 15.6%
(1.76% to 29.4%)		 6
(3 to 57)

Citation

  1. Toracchio S, Celini L, Di Campli E, et al: role of antimicrobial susceptibility testing on efficacy of triple therapy in Helicobacter pylori eradication. Aliment Pharmacol Ther 2000; 14 : 1639-1643
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, January 2002
Reviewer:

Clinical Question.
Patient dyspepsia, H. pylori infection
Intervention or Exposure triple therapy based on antibiotic sensitivity
Comparison empiric triple therapy
Outcome eradication of H.pylori