title: Sequential therapy for Helicobacter pylori eradication: a critical review.
abstract: BACKGROUND
  Alternative treatment regimens for standard triple therapy are urgently needed.
  
  
  OBJECTIVE
  To critically review the evidence on the role of "sequential" regimen for the treatment of Helicobacter pylori infection.
  
  
  METHODS
  Bibliographical searches were performed in MEDLINE and international congresses.
  
  
  RESULTS
  Several pooled-data analyses and meta-analyses have demonstrated that sequential regimen is more effective than standard triple therapy. Sequential therapy is not affected by bacterial (CagA status, infection density) and host factors (underlying disease, smoking). Clarithromycin resistance seems to be the only factor reducing their efficacy. However, even in these patients, an acceptable >75% eradication rate can be achieved. Unfortunately, almost all the studies have been performed in Italy. Whether it is necessary to provide the drugs sequentially or if the 4 components of sequential therapy can be given concurrently is unclear. Nonbismuth quadruple therapy seems to be an effective and safe alternative to triple therapy and is less complex than sequential therapy.
  
  
  CONCLUSIONS
  Sequential therapy is a novel promising treatment approach that deserves consideration as a treatment strategy for H. pylori infection. However, further robust assessment across a much broader range of patients is required before sequential therapy could supplant existing treatment regimens and be generally recommended in clinical practice.
authors.affiliation: Department of Gastroenterology, Hospital Universitario de la Princesa and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain. gisbert@meditex.es
authors.forename: Javier P
authors.initials: JP
authors.lastname: Gisbert
authors.forename: Xavier
authors.initials: X
authors.lastname: Calvet
authors.forename: Anthony
authors.initials: A
authors.lastname: O'Connor
authors.forename: Francis
authors.initials: F
authors.lastname: Mégraud
authors.forename: Colm A
authors.initials: CA
authors.lastname: O'Morain
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents; D017291:Clarithromycin