Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: A randomized study

Nasa, Mukesh; Choksey, Ajay; Phadke, Aniruddha; Sawant, Prabha

doi:10.1007/s12664-013-0357-7

Cited by 24 publications

(19 citation statements)

References 21 publications

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“…A total of 27 full articles and conference abstracts were further assessed for eligibility. After exclusion of trials that used modified sequential therapy ( n = 7) and those included paediatric patients ( n = 7), a total of 13 trials including 5173 patients were eligible for inclusion in this meta‐analysis …”

Section: Resultsmentioning

confidence: 99%

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Systematic review with meta-analysis: 10- or 14-day sequential therapy vs. 14-day triple therapy in the first line treatment ofHelicobacter pyloriinfection

Liou

Chen

Lee

et al. 2015

Aliment Pharmacol Ther

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Summary Background Whether 10‐day or 14‐day sequential therapy is superior to 14‐day triple therapy in the first‐line treatment of Helicobacter pylori remains controversial. Aim To compare the efficacy of 10‐day or 14‐day sequential therapy vs. 14‐day triple therapy. Methods Randomised controlled trials (RCTs) comparing 10‐day or 14‐day sequential therapy and 14‐day triple therapy as first‐line treatment in adults were searched from the PubMed and Cochrane databases from 2000 to October 2015. Abstracts from international annual conferences were also searched. The primary and secondary outcomes were the eradication rate according to the intention‐to‐treat analysis and adverse effects, respectively. Results Of the 109 articles identified, 13 RCTs including 2749 patients in the sequential therapy group and 2424 patients in the 14‐day triple therapy group were eligible. Overall, sequential therapy for 10 or 14 days was not significantly superior to 14‐day triple therapy [Risk ratio (RR) 1.04, 95% confidence interval (CI) 0.99–1.08, P = 0.145]. However, there was significant heterogeneity (I2 = 57.6%, P = 0.005). In the subgroup analysis of four trials, we found that 14‐day sequential therapy was significantly more effective than 14‐day triple therapy (RR: 1.09, 95% CI: 1.04–1.16, P = 0.002), and there was no significant heterogeneity (I2 = 0%, P = 0.624) in this comparison. Sequential therapy given for 10 days was not superior to 14‐day triple therapy (RR: 1.03, 95% CI: 0.98–1.09, P = 0.207). There was no significant difference in the risk of adverse effects. Conclusion Sequential therapy given for 14 days, but not 10 days, was more effective than 14‐day triple therapy as first‐line treatment.

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Section: Resultsmentioning

confidence: 99%

“…Besides, several other randomised trials comparing sequential therapy for either 10 or 14 days with triple therapy for 14 days have been reported after the meta‐analysis by Gatta et al . in 2013 . More importantly, none of the previous meta‐analyses included sequential therapy given for 14 days.…”

Section: Introductionmentioning

confidence: 99%

Systematic review with meta-analysis: 10- or 14-day sequential therapy vs. 14-day triple therapy in the first line treatment ofHelicobacter pyloriinfection

Liou

Chen

Lee

et al. 2015

Aliment Pharmacol Ther

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“…18,24,25 For example, Fakheri and colleagues 18 , reported an eradication rate of 84% by ITT analysis for clarithromycin in quadruple therapy regimen. On the other hand, in contrast to our findings, there are several surveys declared that gemifloxacin was an effective antibiotic for H. pylori eradication.…”

Section: Discussionmentioning

confidence: 99%

Clarithromycin versus Gemifloxacin in Quadruple Therapeutic Regimens for Helicobacter Pylori Infection Eradication

Mansour-Ghanaei

Pedarpour

Shafaghi

et al. 2017

Middle East J Dig Dis

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BACKGROUND Helicobacter pylori (H. pylori) infection is a major casual factor in any peptic diseases. Clarithromycin as one of the drugs recommended for the infection eradication regimen has shown different levels of resistance. The present study is comparing the effectiveness of clarithromycin- and gemifloxacin - based quadruple regimens in H. pylori eradication. METHODS This was a prospective double blind randomized clinical trial on patients with clear indication of H. pylori eradication. The patients were randomly divided into two groups: "BPAC group" treated with bismuth subcitrate (240 mg), pantoprazole (20 mg), amoxicillin (1 gr), and clarithromycin (500 mg), all twice daily, and the "BPAG group" treated with bismuth subcitrate, pantoprazole, and amoxicillin with same doses as "BPAC group" and gemifloxacin (320 mg daily) all for 10 days. Three months after the end of therapy, 14C-Urea breath test was performed to confirm the eradication. All the patients were assessed for compliance and drug side effects. Based on per-protocol (PP) and intention-to-treat (ITT) methods, data were analyzed and a P value<0.05 was considered as statistically significant. This project has been registered in the Iranian registry of clinical trials (IRCT). RESULTS Three patients were excluded from the survey and finally, 179 patients (89 patients in BPAC group and 90 patients in BPAG group) including 71(39.66%) men with the mean age of 46.4±12.3 years completed the treatment period. The incidence of side effects between the two study groups did not differ significantly. The success rate of BPAC regimen eradication was remarkably greater than BPAG regimen (ITT analysis; 89% vs 77%, respectively; CI 95%: 1.072-5.507, P<0.015 and PP analysis; 91% vs 77.8% respectively; CI 95%: P<0.015). There was no significant relationship between the demographic features and the eradication results. CONCLUSION The results showed that gemifloxacin is not a good alternative for clarithromycin in H. pylori eradication regimens in our region.

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“…This regimen includes a PPI and amoxicillin for 5 d, followed by a PPI, clarithromycin, and tinidazole triple therapy for another 5 d. Several studies have indicated that the eradication rate of sequential therapy was significantly higher than that of STT [85][86][87] . The reason that sequential therapy has a higher eradication rate than STT is that amoxicillin and PPI administered during the first 5 d decreases H. pylori density in the stomach, which increases clarithromycin and metronidazole efficacy [32,[88][89][90] .…”

Section: Are There Suitable Sequential and Concomitant Therapy Alternmentioning

confidence: 99%

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Kim

Choi

Chung

2015

WJGPT

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Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori ) has been associated with gastroduodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Core tip: This article reviews the recent literature describing antibiotic resistance and trends in Helicobacter pylori (H. pylori ) treatment. As there is no effective conventional therapy, new treatments are being developed and bismuth quadruple, sequential, concomitant therapies are recommended as a first-line regimen in regions with high levels of clarithromycin resistance. Quinolones have also been used for H. pylori treatment, although the cure rate has gradually reduced with this approach. New therapeutic directions include probiotic supplementation, tailored therapy, novel agents, and nanotechnology.

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Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: A randomized study

Abstract: Sequential therapy was significantly better than standard therapy for eradicating H. pylori infection.

Cited by 24 publications

References 21 publications

Systematic review with meta-analysis: 10- or 14-day sequential therapy vs. 14-day triple therapy in the first line treatment ofHelicobacter pyloriinfection

Systematic review with meta-analysis: 10- or 14-day sequential therapy vs. 14-day triple therapy in the first line treatment ofHelicobacter pyloriinfection

Clarithromycin versus Gemifloxacin in Quadruple Therapeutic Regimens for Helicobacter Pylori Infection Eradication

Antibiotic treatment forHelicobacter pylori: Is the end coming?

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