[Update on the efficacy of triple therapy for Helicobacter pylori infection and clarithromycin resistance rates in Spain (2007-2012)]

Introduction: Triple therapy, which remains the standard treatment for Helicobacter pylori infection, should be discouraged when its efficacy is lower than 80% or when clarithromycin resistance rates are above 15-20%.

Aim: To update the available evidence on the effectiveness of triple therapy and clarithromycin resistance rates in adults in Spain over the last 6 years.

Methods: A literature search (2007-2012) was conducted in Medline and the abstracts books of the annual meetings of several Spanish gastroenterological and microbiological congresses. The search terms were « Helicobacter pylori », « Spain » and « clarithromycin ». Studies were selected if they included triple therapy consisting of a proton pump inhibitor with clarithromycin and amoxicillin or if they analyzed H. pylori clarithromycin susceptibility in treatment-naïve patients.

Results: There were five articles and nine abstracts (3147 patients) on triple therapy, which showed a mean cure rate of 70.8% (95% CI = 66-76%). When stratified by the duration of therapy, the mean cure rates were 68.8% (60-76%) for 7-day regimens and 71.76% (68-78%) for 10-day regimens. For clarithromycin resistance rates, four articles and five abstracts (1709 patients) revealed a mean resistance rate of 18.3% (13-22%).

Conclusions: The efficacy of triple therapy seems to be unacceptable in recent studies conducted in Spain, possibly associated with clarithromcyin resistance rates higher than previously reported.