Ten-day sequential versus triple therapy for Helicobacter pylori eradication: a prospective, open-label, randomized trial.

Abstract

BACKGROUND AND AIM:

Increased resistance of Helicobacter pylori to antibiotics has increased the need to develop new first-line treatments for H. pylori. We have prospectively evaluated 10-day sequential versus conventional triple therapy in peptic ulcer patients.

METHODS:

One hundred and 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 (13) C-urea breath test. Eradication rates, antibiotic resistance rates by agar dilution method, drug compliance, and side-effects were compared.

RESULTS:

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%.

CONCLUSIONS:

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.

• Authors: Jun-Won Chung, Young Kul Jung, Yoon Jae Kim, Kwang Ahn Kwon, Jung Ho Kim, Jong Joon Lee, Sung Min Lee, Ki Baik Hahm, Sun Mi Lee, Jin Yong Jeong, Sung-Cheol Yun
• Journal: Journal of gastroenterology and hepatology (J Gastroenterol Hepatol) Vol. 27 Issue 11 Pg. 1675-80 (Nov 2012) ISSN: 1440-1746 [Electronic] Australia
• PMID: 22849546 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Chemical References

• 2-Pyridinylmethylsulfinylbenzimidazoles
• Anti-Bacterial Agents
• Anti-Ulcer Agents
• Lansoprazole
• Metronidazole
• Amoxicillin
• Urea
• Clarithromycin

Topics

• 2-Pyridinylmethylsulfinylbenzimidazoles (administration & dosage, adverse effects)
• Adult
• Amoxicillin (administration & dosage, adverse effects)
• Anti-Bacterial Agents (administration & dosage, adverse effects)
• Anti-Ulcer Agents (administration & dosage, adverse effects)
• Breath Tests
• Chi-Square Distribution
• Clarithromycin (administration & dosage, adverse effects)
• Confidence Intervals
• Drug Administration Schedule
• Drug Resistance, Multiple, Bacterial
• Drug Therapy, Combination
• Female
• Helicobacter Infections (drug therapy)
• Helicobacter pylori
• Humans
• Intention to Treat Analysis
• Lansoprazole
• Male
• Metronidazole (administration & dosage, adverse effects)
• Middle Aged
• Patient Compliance
• Republic of Korea
• Urea (analysis)