Helicobacter pylori: corrections and comments CMAJ 1997;157:1199 Re: Helicobacter pylori: new developments and treatments, Sander J.O. Veldhuyzen van Zanten and colleagues, CMAJ 1997;156[11]:1565-74 [abstract / résumé] In response to: J. Cooper; P. Cary We would like to thank Janet Cooper for pointing out the errors in our article. Although the dosing schedule from reference 97 was indeed quoted incorrectly, the dosages for omeprazole-BMT quadruple therapy given in Table 1 were correct: omeprazole 20 mg, bismuth subsalicylate 2 tablets qid, metronidazole 250 mg qid and tetracycline 500 mg qid. This was based on our "best estimate" from the published literature, including references 98 and 99 in our paper as well as other recently published studies.1­3 Unfortunately, there are no definitive, head-to-head comparative studies resolving all of the questions about doses and treatment duration. The following issues are still unclear: Is a twice-daily dose of omeprazole better than a once-daily dose? Does treatment with omeprazole before the initiation of BMT improve success? What is the best dose and frequency for metronidazole, and what is the optimal duration of treatment? Future studies should help resolve these uncertainties. Paul Cary is correct in noting that randomized controlled trials (RCT) are the gold standard for the evaluation of new therapies. He is mistaken in stating that few such trials are available for H. pylori. Indeed, several of the studies evaluating treatment that we cited in our paper are high-quality RCTs meeting the criteria of grade I evidence. In fact, for duodenal ulcer trials the evidence is so overwhelming that the US Food and Drug Administration now accepts successful cure of H. pylori infection as a surrogate end-point, and proof of a decrease in the frequency of recurrence of the ulcer is no longer required. Sander J.O. Veldhuyzen van Zanten, MD, PhD Philip M. Sherman, MD Richard H. Hunt, MD Queen Elizabeth II Health Sciences Centre Victoria General Hospital Site Halifax, NS References Hosking SW, Ling TKW, Chung SCS, Yung MY, Cheng AFB, Sung JJY, et al. Duodenal ulcer healing by eradication of Helicobacter pylori without anti-acid treatment: randomized controlled trial. Lancet 1994;343:508-10. De Boer WA, van Etten RJXM, Schade RWB, Ouwehand ME, Schneeberger PM, Tytgat GNJ. 4-day lansoprazole quadruple therapy: a highly effective cure for Helicobacter pylori infection. Am J Gastroenterol 1996;91(9):1778-82. Kung NNS, Sung JJY, Yuen NWF, Ng PW, Wong KC, Chung ECH, et al. Anti-Helicobacter pylori treatment in bleeding ulcers: Randomized controlled trial comparing 2-day versus 7-day bismuth quadruple therapy. Am J Gastroenterol 1997;92(3):438-41. Send a letter to the editor responding to this letter Envoyez une lettre à la rédaction au sujet de cette lettre | CMAJ November 1, 1997 (vol 157, no 9) / JAMC le 1er novembre 1997 (vol 157, no 9) |