Ten-day sequential versus triple therapy for H. pylori eradication: A prospective, open-label, randomized trial
Journal of Gastroenterology and Hepatology, 08/01/2012
Chung JW et al. – Although 10–day sequential therapy yielded a higher H. pylori eradication rate than 10–day conventional triple therapy, the sequential therapy protocol did not result in a sufficiently satisfactory eradication rate. This might be related to the higher antibiotics resistance rate especially to dual resistance. More effective regimens are needed to overcome antibiotic resistance in Korea.Methods
- One hundred fifty–nine patients with peptic ulcer diseases were prospectively randomized to receive 10 days of lansoprazole, amoxicillin, and clarithromycin (conventional triple therapy) or 5 days of lansoprazole and amoxicillin followed by 5 days of lansoprazole, clarithromycin, and metronidazole (sequential therapy).
- Post–treatment H. pylori status was determined by the 13C–urea breath test.
- Eradication rates, antibiotic resistance rates by agar dilution method, drug compliance, and side effects were compared.
- The intention–to–treat eradication rates were 75.9% (95% CI: 66.5–85.3%, 60/79) in the sequential therapy group and 58.7% (95% CI 47.9–69.5%,47/80) in the conventional triple therapy group (P=0.01), while the per–protocol eradication rates were 86.8% (95% CI: 78.7–94.8%, 59/68) and 67.6% (95% CI 56.5–78.7%,46/68) (P=0.01), respectively.
- Compliance and side effects were similar in the two groups.
- Culture of H. pylori showed that 18.2% were resistant to clarithromycin, 41.9% to metronidazole.
- Dual resistance to both antibiotics was 9.6%.