The importance of clarithromycin dose in the management of H. pylori infection: a meta‐analysis of triple therapies with a proton pump inhibitor, clarithromycin and amoxycillin or metronidazole

S IRS, I read with interest the meta-analysis by Dr Huang and Professor Hunt.1 They conclude that ‘clarithromycin 500 mg b.d. should be used in combination with a proton pump inhibitor and…metronidazole…to achieve the best first treatment results’. Their results, however, show that clarithromycin 250 mg b.d. was as effective as clarithromycin 500 mg b.d. for Helicobacter pylori eradication, both in the overall analysis (ITT 87.4% and 88.9%, respectively) and in the four head to head comparative studies. In view of this, I am somewhat surprised that the authors recommend using a double dose of clarithromycin (and double the cost) along with a proton pump inhibitor and metronidazole for eradication of H. pylori.