#56 Is Quadruple the New Triple Therapy for H. Pylori?
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- QT was omeprazole BID with bismuth subcitrate, metronidazole, and tetracycline QID.
- TT was omeprazole, amoxicillin, and clarithromycin BID.
- Concerns: Differing treatment durations, differing antibiotics, bismuth subcitrate not commercially available in Canada, questionable generalizability.
- For example, eradication rate 78% QT and 77% TT.2
- Compliance minimally better with TT in one review (96% versus 92%)3, with no difference in the other.2
- Eradication rates for H. pylori may be suboptimal (<80%) worldwide4-6 due to increasing antibiotic resistance, but are >80% in Canada.7
- Resistance varies by geographical region and local resistance patterns (which are often not known).8
- Clarithromycin resistance should guide initial H. pylori treatment choices.
- Avoid if resistance rates ≥ 20%.9
- Canadian recommendations include both triple or quadruple therapy as first line therapies for H. pylori eradication, but prefer TT due to demonstrated equivalency and ease of dosing.10
- Cost effectiveness data comparing QT and TT and length of therapy is lacking.
- Emerging H. pylori eradication therapies that may have superior eradication rates compared with QT or TT (but whose results in North American patients are lacking) include:11-14
- Sequential therapy (10 -14 days): Amoxil plus PPI for 5-7 days, then Metronidazole, Clarithromycin, and PPI for 5-7 days.
- Concomitant therapy (TT plus metronidazole) for 7-14 days.