High eradication rates of Helicobacter pylori with a new sequential treatment.
BACKGROUND
Eradication rates of Helicobacter pylori with standard triple therapy are disappointing, and studies from several countries confirm this poor performance.


OBJECTIVE
To assess the eradication rate of a new sequential treatment regimen compared with conventional triple therapy for the eradication of H. pylori infection.


METHODS
One thousand and forty-nine dyspeptic patients were studied prospectively. H. pylori-infected patients were randomized to receive 10-day sequential therapy [rabeprazole (40 mg daily) plus amoxicillin (1 g twice daily) for the first 5 days, followed by rabeprazole (20 mg), clarithromycin (500 mg) and tinidazole (500 mg) twice daily for the remaining 5 days] or standard 7-day therapy [corrected] [rabeprazole (20 mg), clarithromycin (500 mg) and amoxicillin (1 g) twice daily]. H. pylori status was assessed by histology, rapid urease test and 13C-urea breath test at baseline and 6 weeks or more after completion of treatment.


RESULTS
Higher eradication rates were found with the sequential regimen compared to the standard regimen (intention-to-treat: 92% vs. 74%, P < 0.0001; per protocol: 95% vs. 77%, P < 0.0001). Higher eradication rates were also seen in patients with peptic ulcer disease and non-ulcer dyspepsia. In both treatments, compliance was similar (> 90%), as was the rate of side-effects, which were mild.


CONCLUSIONS
This 10-day sequential treatment regimen achieves high eradication rates in peptic ulcer disease and non-ulcer dyspepsia.
Zullo
A
A
GI Unit, Nuovo Regina Margherita Hospital, Rome, Italy. zullo@tiscali.it
Vaira
D
D
Vakil
N
N
Hassan
C
C
Gatta
L
L
Ricci
C
C
De Francesco
V
V
Menegatti
M
M
Tampieri
A
A
Perna
F
F
Rinaldi
V
V
Perri
F
F
Papadìa
C
C
Fornari
F
F
Pilati
S
S
Mete
L S
LS
Merla
A
A
Potì
R
R
Marinone
G
G
Savioli
A
A
Campo
S M A
SM
Faleo
D
D
Ierardi
E
E
Miglioli
M
M
Morini
S
S
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000658:Amoxicillin / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D004415:Dyspepsia / Q000382:microbiology*; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000031:analogs & derivatives; D010349:Patient Compliance; D064750:Rabeprazole; D014011:Tinidazole / Q000627:therapeutic use*; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D001562:Benzimidazoles; D014011:Tinidazole; D064750:Rabeprazole; D000658:Amoxicillin; D017291:Clarithromycin; D009853:Omeprazole