The Lancet has featured a study evaluating a 3-drug regimen of a proton-pump inhibitor plus amoxicillin and clarithromycin (commonly used in Europe and North America), with a 5-day concomitant and 10-day sequential four-drug regimens that include a nitroimidazole (commonly used in Latin America), for the treatment of Helicobacter pylori infection. The study, conducted in Latin America involved 1463 patients aged between 21 and 65 years, who tested positive for H pylori infection, and who were randomised to one of the following:

• 14 days of lansoprazole, amoxicillin, and clarithromycin (standard therapy) (n=488);

• 5 days of lansoprazole, amoxicillin, clarithromycin, and metronidazole (concomitant therapy) (n=489);

• 5 days of lansoprazole and amoxicillin followed by 5 days of lansoprazole, clarithromycin, and metronidazole (sequential therapy) (n=486).

Eradication was assessed by urea breath test 6—8 weeks after randomisation. The trial was not masked, and the primary outcome was the probablity of H pylori eradication.

The researchers reported that the probability of eradication with standard therapy was 82.2% (401 of 488), which was 8.6% higher (95% adjusted CI 2.6—14.5) than with concomitant therapy (73.6% [360 of 489]) and 5.6% higher (—0.04% to 11.6) than with sequential therapy (76.5% [372 of 486]).  They concluded that the standard 14-day triple-drug therapy is preferable to 5-day concomitant or 10-day sequential four-drug regimens as empiric therapy for H pylori infection in the diverse Latin American populations evaluated in this study.

[Please note, at the time of writing, only the abstract was available, therefore access to full statistical data was limited]