Standard triple therapy versus sequential therapy for eradication of Helicobacter pylori in treatment naïve and retreat patients

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• 作者：Adnan Abuhammour^a ; ^{aabuhammour@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Asad Dajani^b ; Mohammed Nounou^c ; Mohammed Zakaria^d
• 关键词：H. pylori ; Sequential ; Triple therapy ; Clarithromycin resistance
• 刊名：Arab Journal of Gastroenterology
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：17
• 期：3
• 页码：131-136
• 全文大小：435 K

文摘

Untreated Helicobacter pylori infection causes increased risk of gastric cancer, GI morbidity and mortality. Standard treatment for eradication of Helicobacter pylori infection, is the triple therapy which consists of a proton pump inhibitor; together with two antibiotics (amoxicillin 1000 mg with clarithromycin 500 mg or metronidazole 400 mg) given twice daily for 7–14 days. Recent evidence revealed, that cure rates of Helicobacter pylori infection with triple therapy had fallen below satisfactory targets. Sequential therapy consisting of a twice daily dose of a PPI for ten days with Amoxicillin given at 1000 mg twice daily in the first 5 days followed by clarithromycin 500 mg and Metronidazole 400 mg given twice daily in the subsequent 5 days, was recommended to improve eradication rates. We performed a randomised open label study to compare the efficacy of sequential against triple therapy in Helicobacter pylori naive and retreat patients.

Patients and methods

In a randomised open label observational study 485 patients fulfilling inclusion and exclusion criteria were randomly assigned to be treated with triple therapy (n = 231) or sequential therapy (n = 254). Eradication of Helicobacter pylori was documented with ¹⁴C Urea breath test (UBT) performed 6 weeks after the treatment.

Results

The intention-to-treat eradication rate was better in sequential therapy group 84.6% than triple therapy 68% (p < 0.001). Eradication rates were significantly higher for treatment naive than retreat patients in triple therapy group (70.5% and 58.3%, respectively, p < 0.01). A trend of a better response was observed in eradication rate for treatment naive 88.55% versus retreat 74.6% in sequential therapy group but was not statistically significant (p = 0.76). Compliance was similar in the two groups, however side effects were less and the clinical response was better in the sequential therapy group.