Sequential Therapy or Standard Triple Therapy for Helicobacter pylori Infection

Abstract

The effectiveness of standard triple therapy (STT) for the eradication of Helicobacter pylori has decreased recently. Sequential therapy (SQT) is a new regimen proposed to address this problem. The aim of this study was to compare the efficacy of SQT versus STT for H. pylori eradication. We searched The Cochrane Library, MEDLINE, Web of Science, and EMBASE databases up to July 2014. The risk ratios (RRs) of eradication rate were pooled, with a 95% confidence interval (CI). Thirty-six randomized clinical trials including a total of 10,316 patients met the inclusion criteria. The RR for eradication of H. pylori with SQT compared with STT was 1.14 (95% CI: 1.09-1.17), the eradication rates were 84.1% and 75.1%, respectively. There was significant heterogeneity between trial results (I = 73%; P < 0.00001). Subgroup analyses showed that SQT was superior to both 7- and 10-day STT, but not significantly better than 14-day STT. This superiority existed when patients were treated with either metronidazole or tinidazole. Patients with single clarithromycin-resistant strain showed a greater benefit of SQT over STT (eradication rates 80.9% vs. 40.7%), RR = 1.98 (95% CI: 1.33-2.94). There was no significant difference between groups in terms of the risk of adverse effects. In conclusion, SQT is more efficacious than STT (7 days and 10 days) in the eradication of HP, but the pooled rate seemed suboptimal. Further research is needed to develop more effective therapeutic approaches. Surveillance of resistance rates should be performed to guide treatment.

Randomized Controlled Trial for Helicobacter pylori Eradication in a Naive Portuguese Population: Is Sequential Treatment Superior to Triple Therapy in Real World Clinical Setting?

“…23 In a meta-analysis from Gatta et al, 16 ST was superior to 7-day and 10-day TT, but no advantage of ST was observed if TT was prolonged for 14 days (eradication rates 80.8% vs 81.3%, respectively), reflecting an improvement between 5.0% and 9.8% 1,16 in TT eradication rates with a 14-day course, and these results were replicated subsequently in another meta-analysis by Feng et al 24 Prospective Western European studies directly comparing 14-day TT with 10-day ST are currently lacking.…”

Eradication Rates in Italian Subjects Heterogeneously Managed for Helicobacter pylori Infection. Time to Abandon Empiric Treatments in Southern Europe

“…However, in our series, the sequential therapy allowed a high eradication rate (89%), even though enrolled patients lived in a geographical area characterized by high clarithromycin resistance. This outcome was probably due to the presence of tinidazole-susceptible H. pylori strains [1,49,50]. Evidence suggests that the sequential therapy besides being highly effective (91.1% and 92.1% eradication rates at ITT and PP analysis) [9], can overcome the issue of clarithromycin resistance [47].…”

Treatment of Helicobacter pylori infection 2017

“…A further study from the United Arab Emirates also showed such a result (84.6% vs 68%) . Two systematic reviews and meta‐analyses of sequential therapy vs triple therapy found sequential treatment to be significantly more effective (82% vs 75% and 84.1% vs 75.1%, respectively) . However, on subgroup analysis, both confirmed no benefit for sequential when longer triple therapy regimens were used.…”