Eradication of Helicobacter pylori: the end of the line for standard triple therapy?

Authors

  • António Assunção Silva Médico interno de Medicina Geral e Familiar. na USF MaxiSaúde, Braga.
  • Rui Macedo Médico Especialista em Medicina Geral e Familiar e orientador de formação na USF MaxiSaúde, Braga
  • Dina Novais Fernandes Médica interna de Medicina Geral e Familiar na USF +Carandá, Braga
  • Luís Sousa Médico interno de Medicina Geral e Familiar na USF +Carandá, Braga
  • Adriana Miranda Médica interna de Medicina Geral e Familiar na USF Pró-Saúde, Vilaverde

DOI:

https://doi.org/10.32385/rpmgf.v31i6.11624

Keywords:

Helicobacter pylori, Drug Therapy, Disease Eradication

Abstract

Objectives: To review the evidence for the effectiveness of triple therapy (TT) and sequential therapy (TS) in the eradication of Helicobacter pylori infection (H. pylori). Data sources: MEDLINE and evidence-based medicine websites. Methods: We conducted a search for clinical practice guidelines (CPG), systematic reviews (SR), meta-analyses (MA) and randomized clinical trials (RCT), published between June, 2004 and June, 2014, using the MeSH terms ‘Helicobacter pylori’, ‘Drug therapy’ and ‘Disease eradication’. The Strength of Recommendation Taxonomy (SORT) was used for the assignment of levels of evidence and the strength of recommendations. Results: A total of 15 articles were selected out of 227 articles found. These included 3 CPG, 8 MA, 2 RS and 2 RCT. The CPG recommend TT as the preferred treatment. The 8 MA and 2 RS showed the superiority of ST in the eradication of Helicobacter pylori (ranging from 81 to 95.6%) compared to the TT (for 7-10 days, consistently <80%). The 2 EAC had overlapping findings with the MA and RS. Conclusions: TS has superior efficacy compared to TT and should be considered as the first line of therapy for eradication of H. pylori infection (SOR A). When compared to TT for 14 days, conventional TS appears to have a similar rate of eradication. When given for more 14 days, TS is better than TT (SOR B). In areas of high resistance to clarithromycin, metronidazole or both, as in Portugal, TS is better than TT (SOR A).

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Published

2015-11-01

Issue

Vol. 31 No. 6 (2015): Revista Portuguesa de Medicina Geral e Familiar

Section

Reviews

License

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How to Cite

Eradication of Helicobacter pylori: the end of the line for standard triple therapy?. (2015). Portuguese Journal of Family Medicine and General Practice, 31(6), 392-400. https://doi.org/10.32385/rpmgf.v31i6.11624