Fourteen days is ideal treatment duration for Helicobacter pylori eradication

Clinical question: 
What is the optimal duration of treatment for eradicating Helicobacter pylori infection?
Bottom line: 
For proton pump inhibitor (PPI)+clarithromycin+amoxicillin (PCA), prolonging treatment duration from 7 to 10 days, or from 10 to 14 days, is associated with a significantly higher eradication rate. The optimal duration of therapy for PCA and PPI+amoxicillin+nitroimidazole (PAN) is at least 14 days. More data are needed to confirm if there is any benefit of increasing the duration of therapy for PPI+clarithromycin+nitroimidazole (PCN) therapy.
Caveat: 
Overall, the quality of evidence for the outcome of H. pylori persistence for PPI triple therapy was moderate because of study limitations (risk of bias). For certain subgroups, the quality of the evidence for the outcome H. pylori persistence was low (eg, PCN 14 days versus 7 days) or very low (eg, PCN 10 days versus 7 days) because of study limitations.
Context: 
A PPI plus 2 antibiotics is the most commonly used first treatment to eradicate H. pylori infection. The ideal duration of therapy for H. pylori eradication is controversial, with recommendations ranging from 7 to 14 days.
Review CD#: 
CD008337
PEARLS No: 
441
Date: 
August, 2014
Authored by: 
Brian R McAvoy