The sequential therapy regimen for Helicobacter pylori eradication.
BACKGROUND
Standard triple therapy (STT) is the most used treatment for Helicobater pylori infection. The prevalence of antibiotic resistance has increased substantially in recent years and there has been a corresponding decrease in efficacy.


METHODS
Bibliographical searches were performed in MEDLINE and international congresses up to 2009 for 'Helicobacter pylori' AND 'sequential regimen/therapy'.


RESULTS
Several meta-analyses have demonstrated that sequential therapy (SQT) is more effective than STT. SQT is not affected by bacterial and host factors that have, until now, predicted the outcome of STT. Primary clarithromycin resistance is the only factor reducing the efficacy of SQT; however, even in these patients an acceptable > 75% eradication can be achieved. So far, almost all the studies have been performed in Italy. The advantages of SQT over STT should be confirmed in different countries. Whether it is necessary to provide the drugs sequentially or if the four components of SQT can be given concurrently is unclear.


CONCLUSIONS
SQT is a promising new 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 SQT could supplant existing treatment regimens and be generally recommended in clinical practice.
Gisbert
Javier P
JP
Department of Gastroenterology, Hospital Universitario de la Princesa and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 62 Diego de Leon, 28006 Madrid, Spain. gisbert@meditex.es
Calvet
Xavier
X
O'Connor
J P Anthony
JP
Mégraud
Francis
F
O'Morain
Colm A
CA
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D016527:Drug Costs; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D016480:Helicobacter pylori / Q000472:pathogenicity*; D006801:Humans; D018579:Patient Selection; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000191:economics; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors