One-day quadruple therapy compared with 7-day triple therapy for Helicobacter pylori infection

Arch Intern Med. 2003 Sep 22;163(17):2079-84. doi: 10.1001/archinte.163.17.2079.


Background: Eradication of Helicobacter pylori infection has had an impact on the treatment and recurrence rates of peptic ulcer disease and malignancies such as mucosa-associated lymphoid tissue lymphoma. Treatment options are cumbersome, expensive, and associated with side effects.

Methods: Randomized, prospective, open-labeled equivalence trial with a parallel-group design to compare eradication rates of H pylori with a 1-day, 4-drug regimen with a 7-day, 3-drug regimen. A total of 160 patients with dyspepsia and a Glasgow Dyspepsia Severity Score of at least 3 had a urea breath test labeled with carbon 14. Patients who tested positive were randomized to 1 of the 2 study groups. The study was designed to test the therapeutic equivalence of 1-day and 7-day regimens based on the percentage of H pylori eradication in each group at 5 weeks.

Results: The 1-day treatment group (n = 80) had a slightly higher eradication percentage (95%) than the 7-day group (90%). The possible inferiority of the 1-day treatment relative to the 7-day treatment, a 15% difference in the number of patients whose infection was not eradicated at 5 weeks, was rejected (P<.001; 90% confidence interval, 2.7%-11%). Both groups demonstrated a mean decrease of 7.5 points in the Glasgow Dyspepsia Severity Score. The 2 groups showed no significant differences in side effects. Patients whose treatment failed (4 in the 1-day treatment group and 7 in the 7-day treatment group) were re-treated for 10 days. One patient from the 7-day treatment group still tested positive after the second treatment.

Conclusions: The 1-day treatment proved to be statistically similar to the 7-day treatment for the eradication of H pylori in patients with dyspepsia and a positive urea breath test. Further evaluation will be necessary to determine whether the 1-day regimen is adequate for patients with peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, or gastric adenocarcinoma.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Adult
  • Aged
  • Amoxicillin / administration & dosage*
  • Anti-Bacterial Agents / administration & dosage*
  • Bismuth / administration & dosage*
  • Breath Tests
  • Drug Therapy, Combination
  • Dyspepsia / drug therapy
  • Dyspepsia / etiology
  • Dyspepsia / microbiology
  • Female
  • Helicobacter Infections / complications
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori*
  • Humans
  • Lansoprazole
  • Male
  • Metronidazole / administration & dosage*
  • Middle Aged
  • Omeprazole / administration & dosage*
  • Omeprazole / analogs & derivatives*
  • Organometallic Compounds / administration & dosage*
  • Prospective Studies
  • Proton Pump Inhibitors*
  • Salicylates / administration & dosage*
  • Severity of Illness Index
  • Treatment Outcome


  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Anti-Bacterial Agents
  • Organometallic Compounds
  • Proton Pump Inhibitors
  • Salicylates
  • Lansoprazole
  • Metronidazole
  • bismuth subsalicylate
  • Amoxicillin
  • Omeprazole
  • Bismuth