What is the Best Strategy for Treating Helicobacter pylori?

The most popular treatment for H pylori is triple therapy but resistance to Clarithromycin is reducing its effectiveness. Courses using four drugs have been known to be more successful but are used less popular because of their side effects. So, what is the best way for treating H pylori-related diseases.

A research article published in June in the World Journal of Gastroenterology addresses this question. The research team led by professor Siok Ching from the United Kingdom compared a lansoprazole-based triple versus quadruple therapy for H pylori eradication with emphasis on side effect profile, patient compliance and eradication rate at a rural district general hospital in Wales, United Kingdom.

Overall, the treatment of H Pylori using both three drugs and four drugs are still highly effective in rural North Wales (92 percent), however, almost all (97 percent) of the patients who managed to complete the course of four tablets got rid of the infection.

The authors feel that treatments with four drugs remain the best option in rural UK. Patients need educating about the side effects of the drugs and the reasons for treatment so that they can reap the full benefits.

They concluded that one-week triple and quadruple therapies have similar intention-to-treat eradication rates. Certain side effects are more common with quadruple therapy, which can compromise patient compliance. Patient education or modifications to the regimen are alternative options to improve compliance of the quadruple regimen.

The side effects may be reduced by replacing metronidazole with amoxycillin but patients should be better educated about the side effects in order to improve compliance and cure rates.

Reference: Ching SS, Sabanathan S, Jenkinson LR. Treatment of H pylori in surgical practice: A randomised trial of triple versus quadruple therapy in a rural district general hospital. World J Gastroenterol 2008; 14(24): 3855-3860