In the primary analysis, eradication frequency was 83·7% for triple therapy for 14 days (lansoprazole 30mg, amoxicillin 1g, and clarithromycin 500mg BD), 85·9% for concomitant therapy for 10 days (lansoprazole 30mg, amoxicillin 1g, clarithromycin 500mg, and metronidazole 500mg BD), and 90·4% for bismuth quadruple therapy for 10 days (bismuth tripotassium dicitrate 300mg QDS lansoprazole 30mg BD tetracycline 500mg QDS and metronidazole 500mg TDS).
A commentary notes that this research has made substantial inroads into understanding unintended consequences of screen-and-treat programmes, however, the results are only marginally reassuring; and much more needs to be learned about the immunological, metabolic, and, particularly, microbiological consequences of H pylori treatment. It adds that the paper only scrapes the surface of antimicrobial resistance, looking at only faecal organisms and not organisms that might gain resistance to the antibiotics typically used for H pylori eradication (i.e, metronidazole, tetracycline, and clarithromycin). It warns that “in this era of rapidly increasing and life-threatening antimicrobial resistance, it is sobering to think that a macrolide—one of the few remaining alternatives for treating extremely drug-resistant typhoid—might be widely used in healthy adults to prevent a disease that will only afflict a small percentage.” It acknowledges that these hypothetical concerns need to be balanced with the incidence and lethality of gastric malignancy.