It is unclear whether intention-to-treat (ITT) or per-protocol (PP) eradication rates were used in this study. A Cochrane systematic review was conducted this year on what the optimum duration of therapy is for H. pylori http://www.selleckchem.com/products/AP24534.html eradication treatment [3]. This review looked at 75 eligible studies and concluded that increasing the duration of PPI-based triple therapy increases H. pylori eradication rates and that for therapy with PPI, clarithromycin, and amoxicillin, which remains the most commonly used combination, prolonging treatment duration from 7

to 10 or from 10 to 14 days is associated with a significantly higher eradication rate, with the optimal duration of therapy being of at least 14 days. The eradication rate reported, as first-line therapy, for PPI, amoxicillin,

and clarithromycin lasting 14 days was 83.5%; for PPI, clarithromycin, and metronidazole lasting 14 days, the rate was 68.6%; and for PPI, amoxicillin, and metronidazole, it was 82%. This was confirmed by another study from Canada that found 14 days of therapy to be clearly superior to 7 days (83 vs 64%, respectively) [4]. It is clear that multiple factors influence treatment success, and one study from Korea this year set out to address these various factors [5]. They found that age ≥50 years, female gender, BMI <25 kg/m2, amoxicillin, and/or clarithromycin resistance were associated with treatment failure by univariate analysis. In addition, the slow metabolizer genotype of CYP2C19 showed a higher eradication rate compared with the rapid metabolizer (86.8 vs 78.2%, p = .035).

find more MI-503 in vitro However, by multivariate analysis, only clarithromycin resistance was statistically significant. Such factors have led to an attempt to explore whether tailored therapy would be more efficacious. Two studies looked at tailoring therapy to clarithromycin resistance. One study found that tailoring triple therapy based on clarithromycin susceptibility prior to therapy yielded an overall 96.7% eradication rate, consisting of 95.5% eradication rates when clarithromycin was used and 98.4% when metronidazole was used (i.e. for clarithromycin-resistant strains) [6]. In this study, four times daily dosing of PPI and amoxicillin was used to optimize acid inhibition. The other study tailored treatment based on the detection of 23S ribosomal RNA point mutations and found significantly higher eradication rates compared with controls [7]. A study from Thailand reported 100% rates of eradication among rapid CYP2C19 metabolizers when 14-day regimens were used [8]. Another study this year showed that substituting azithromycin to clarithromycin as part of a standard triple therapy led to comparable results (75 vs 83%) which may have some significance in areas of economic disadvantage [9].