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World J Gastroenterol. Jun 7, 2007; 13(21): 2967-2972
Published online Jun 7, 2007. doi: 10.3748/wjg.v13.i21.2967
Optimal length of triple therapy for H pylori eradication in a population with high prevalence of infection in Chile
Arnoldo Riquelme, Alejandro Soza, Cesar Pedreros, Andrea Bustamante, Felipe Valenzuela, Francisco Otarola, Eduardo Abbott, Marco Arellano, Brenda Medina, Alejandro Pattillo, Douglas Greig, Marco Arrese, Antonio Rollan
Arnoldo Riquelme, Alejandro Soza, Marco Arrese, Antonio Rollan, Department of Gastroenterology, Pontificia Universidad Católica de Chile
Francisco Otarola, Eduardo Abbott, Marco Arellano, Alejandro Pattillo, Douglas Greig, Department of Internal Medicine, Pontificia Universidad Católica de Chile
Cesar Pedreros, Andrea Bustamante, Felipe Valenzuela, Brenda Medina, Hospital de Urgencia Asistencia Pública, Santiago, Chile
Author contributions: All authors contributed equally to the work.
Correspondence to: Arnoldo Riquelme, MD, Department of Gastroenterology, Pontificia Universidad Católica de Chile, Marcoleta 367, Casilla 114-D, Santiago, Chile. arnoldoriquelme@gmail.com
Telephone: +56-2-3543820 Fax: +56-2-6397780
Received: January 4, 2007
Revised: February 25, 2007
Accepted: March 15, 2007
Published online: June 7, 2007
Abstract

AIM: To compare the efficacy of 7-d versus 14-d triple therapy for the treatment of H pylori infection in Chile, with a prevalence of 73% in general population.

METHODS: H pylori-infected patients diagnosed by rapid urease test, with non-ulcer dyspepsia or peptic ulcer disease were randomized to receive omeprazole 20 mg bid, amoxicillin 1 g bid, and clarithromycin 500 mg bid for 7 (OAC7) or 14 (OAC14) d. Primary outcome was eradication rate 6 wk after the treatment. Subgroup analysis was carried out considering the eradication rate among patients with or without peptic ulcer disease and eradication rate among smokers or non-smokers.

RESULTS: One hundred and thirty-one patients were randomized to OAC7 (n = 69) or OAC14 (n = 62). The overall eradication rate (intention-to-treat) was 78.3% in OAC7 and 85.5% in OAC14 groups, without a significant difference (P =0.37). No significant difference in the eradication rate was found among the patients with peptic ulcer disease (n = 31) between the OAC7 group (85.7%) and OAC14 group (87.5%). However, smokers had an obviously lower eradication rate compared to non-smokers, particularly in the OAC7 group (57.1% in smokers vs 83.6% in non-smokers; P = 0.06). Adverse effects rate were similar between both groups.

CONCLUSION: Short-term efficacy of triple therapy with OAC for 7 d is comparable to 14 d in this high-prevalence population. Longer follow-up, and studies focused to some subgroups of patients (smokers and non-ulcer patients) are necessary to support widespread use of 7-d instead of 10-14-d triple therapy in a developing country like Chile.

Keywords: Helicobacter pylori; Antibiotic treatment; Omeprazole; Amoxicillin; Clarithromycin; Quasi-randomized controlled trial