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Triple therapy that includes a proton pump inhibitor is an established treatment for Helicobacter pylori infection. At least one European guideline recommends that patients take their triple therapy for two weeks to maximise the chance of complete eradication. A new meta-analysis suggests that seven days is probably enoughenough.
The pooled results of 21 trials showed that seven days of treatment cures between 73% and 77% of patients, compared with a cure rate of 81% for 10 days of treatment, and 78% for 14 days. Overall, the differences weren't significant.
When the researchers confined their analysis to trials of triple therapy with amoxicillin, longer treatment was associated with a small but significant benefit (relative risk of eradication 1.05, 95% CI 1.01 to 1.10 for 10 days v seven days; 1.07, 1.02 to 1.12 for 14 days v seven days). The trials in this meta-analysis were of poor quality, so the results of this subgroup analysis are unlikely to be secure enough to inform treatment recommendations, say the authors. Doctors should stick to seven days of treatment until we have better data on side effects and more trials evaluating metronidazole regimens.