Standard Triple Therapy versus Sequential Therapy inHelicobacter pyloriEradication: A Double-Blind, Randomized, and Controlled Trial

Abstract

Aim. To compare 10-day standard triple therapy versus sequential therapy as first-line treatment in patients infected with H. pylori. Methods. One hundred H. pylori positive patients (diagnosed by rapid urease test and histology), with average age of 47.2, M/F = 28/72, were randomized to receive either standard triple treatment (TT) as follows: lansoprazole 30 mg, clarithromycin 500 mg, and amoxicillin 1 g, b.i.d. for ten days, or sequential treatment (ST) as follows: lansoprazole 30 mg, amoxicillin and placebo 1.0 g b.i.d for the first five days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and tinidazole 500 mg b.i.d, for the remaining five days. Eradication rates were determined 60 days after treatment by urease, histology, or 13C-urea breath test. Results. In intention to treat (ITT) analysis, the rate of H. pylori eradication in the TT and ST groups was the same for both regimens as follows: 86% (43/50), 95% CI 93,3 to 73.4%. In Per protocol (PP) analysis, the rate of H. pylori eradication in the TT and ST groups was 87.8% (43/49), 95% CI 94,5 to 75.3% and 89.6% (43/48), 95% CI 95,8 to 77.3%, respectively. Conclusions. In Brazil, standard triple therapy is as equally effective as sequential therapy in eradicating Helicobacter pylori patients. This study was registered under Clinical Trials with number ISRCTN62400496.

Ivth Brazilian Consensus Conference on Helicobacter Pylori Infection

“…This therapy is complex, highly variable in different regions, and the results are similar to those of concomitant therapy and 14day triple therapy (390) . In Brazil, a study comparing sequential therapy showed that the rate of eradication of HP (86%) was similar to that of standard triple therapy for 10 days (391) . Furthermore, data on the outcomes of hybrid therapy (PPI associated with amoxicillin for 5-7 days followed by PPI, amoxicillin, clarithromycin, and metronidazole for another 5-7 days) as the first-line option are limited and inconsistent (40) .…”

Comparison of 10 and 14 days of triple therapy versus 10 days of sequential therapy for Helicobacter pylori eradication: A prospective randomized study

“…In addition, several studies conducted in different countries have compared 10 days of ST with 7 days of TT and have demonstrated some favorable results for ST; a trial from Ireland found a superior result for ST (68% vs. 55%) (22). A study from Taiwan also showed a favorable result for ST, whereas a study from Brazil found equal eradication rates (86%) for both regimens (21,23).…”

Investigating the Efficacy of Triple Drug Therapy and Sequential Drug Therapy in the Eradication of Helicobacter Pylori with Respect to Antigen Stool test: A Pilot Study

“…Recent evidence also showed no significant difference in eradication rates in standard triple drug therapy (87.8%) and sequential drug therapy (89.6%) concluding that both the regimens were equally effective. 42 Several studies in the literature have shown that the effectiveness of the standard triple drug therapy has been declining over the past years, mainly due to clarithromycin resistance, especially in the USA and Europe. [43][44][45] For this reason, sequential therapy has been assessed, with eradication rates greater than 90% as study conducted previously.…”