Business Wire - Court of Appeals Upholds Merck’s Patent for FOSAMAX-R-
* EVIDENCE-BASED ANSWER
Fourteen-day triple therapy with a proton pump inhibitor (PPI) plus clarithromycin and either amoxicillin or metronidazole is superior to 7-day therapy in eradicating Helicobacter pylori (strength of recommendation [SOR]: A, high-quality meta-analysis).
Seven-day triple therapy with a PPI or ranitidine bismuth citrate plus clarithromycin and either amoxicillin or metronidazole is also effective (SOR: A, high-quality systematic review).
Three-day quadruple therapy with a combination of PPI, clarithromycin, bismuth subcitrate, and metronidazole or a combination of PPI, clarithromycin, amoxicillin, and metronidazole also appears to be effective (SOR: B, unblinded randomized controlled trial).
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* EVIDENCE SUMMARY
The ideal H pylori eradication regimen should reach an intention-to-treat cure rate of 80% (Table). (1) Effective regimens are:
Fourteen-day triple therapy of PPI clarithromycin metronidazole or amoxicillin. A meta-analysis of 13 studies found the eradication rate for 14-day therapy was 81% (95% confidence interval [CI], 77%-85%), compared with 72% (95% CI, 68%-76%) for 7-day therapy. The eradication rate for 10-day therapy (83%; 95% CI, 75%-89%), however, was not significantly better than that for 7-day therapy (80%; 95% CI, 71%-86%). (2) Side effects were more frequent in the longer therapies, but did not lead to discontinuation of therapy.
Seven-day triple therapy of PPI clarithromycin metronidazole or amoxicillin. A high-quality systematic review of 82 studies using 7-day triple therapy found clarithromycin 500 twice daffy yielded a higher eradication rate than clarithromycin 250 mg twice daily when combined with a PPI and amoxicillin (87% vs 81%; P
