A meta-analysis of short versus long therapy with a proton pump inhibitor,clarithromycin and either metronidazole or amoxycillin for treating Helicobacter pylori infection

Background: Although triple therapies with a proton pump inhibitor, clarith romycin and either amoxycillin or metronidazole are the most widely accepte d treatment for Helicobacter pylori infection, there is no consensus on how long treatment should be maintained for. Aim: To evaluate whether increasing the length of triple therapies beyond 7 days improves treatment efficacy. Methods: An extensive search of the literature was performed. Reports of ra ndomized trials comparing different lengths of therapy were selected. Short (7-day) vs. long (10/14-day) therapies were compared, and three-way compar ison of 7-day vs. 10-day, 10-day vs. 14-day and 7-day vs. 14-day therapies was performed. Meta-analysis was conducted using conventional shareware (Re view Manager 4.0). The Peto Odds Ratio using a fixed model analysis was cal culated for each comparison. Results: Thirteen studies were identified. Pooled 10- to 14-day therapies a chieved better results than 7-day schedules. In head-to-head comparisons, o nly 14-day therapies were significantly better than 7-day treatments. Impro vement in cure rates ranged from 7 to 9%. Comparisons of 7-day vs. 10-day a nd 10-day vs. 14-day also showed a non-significant trend towards better cur e rates with longer therapies. Conclusions: Fourteen-day, proton pump inhibitor-based triple therapy achie ves better results than 7-day schedules. Additional data are necessary to e valuate 10-day therapies.