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M. Brian Fennerty, MD; T. O. G. Kovacs, MD; R. Krause, MD; M. Haber, MD; A. Weissfeld, MD; N. Siepman, MD; P. Rose, MD

Arch Intern Med. 1998;158:1651-1656.

Background  Data from large, multicenter, US studies determining the efficacy of triple therapy for the eradication of Helicobacter pylori are lacking, especially for a treatment duration of less than 14 days.

Methods  Patients with H pylori infection and active duodenal ulcer disease or a history of duodenal ulcer disease within the past year were randomized to receive 30 mg of lansoprazole, 1 g of amoxicillin, and 500 mg of clarithromycin twice daily for 10 or 14 days. The primary efficacy end point was the eradication of H pylori as confirmed by negative histological and culture results at 4 to 6 weeks after the completion of treatment.

Results  Of 284 patients enrolled in the study from 46 US sites, 236 met the entry criteria. At 4 to 6 weeks after the end of therapy, H pylori was eradicated in 85% (96/113) of the patients receiving 14-day triple therapy and in 84% (103/123) of those receiving 10-day triple therapy by per-protocol analysis (95% confidence interval for treatment group differences,-10.5 to 8.1; P>.05). There was also no significant difference between the 14- and 10-day treatment groups when analyzed by an intent-to-treat analysis of H pylori eradication. A similar proportion of patients in each treatment group reported an adverse event related to therapy (34% [46/136] vs 38% [56/148], respectively).

Conclusions  In patients with an active or a recent history of duodenal ulcer, lansoprazole-based triple therapy for 10 or 14 days is highly effective in the eradication of H pylori. The duration of therapy may be reduced from 14 to 10 days without a significant effect on regimen efficacy.

From the Division of Gastroenterology, Oregon Health Sciences University, Portland (Dr Fennerty); the Center for Ulcer Research and Education, Los Angeles, Calif (Dr Kovacs); Allegheny University of the Health Sciences, Philadelphia, Pa (Dr Haber); Microbiology Specialists Inc, Houston, Tex (Dr Weissfeld); and TAP Holdings, Deerfield, Ill (Drs Siepman and Rose). Dr Krause is in private practice, Chattanooga, Tenn.

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