Standard triple, bismuth pectin quadruple and sequential therapies for Helicobacter pylori eradication.
OBJECTIVE
To compare the effectiveness of standard triple, bismuth pectin quadruple and sequential therapies for Helicobacter pylori (H. pylori) eradication in a randomized, double-blinded, comparative clinical trial in China.


METHODS
A total of 215 H. pylori-positive patients were enrolled in the study and randomly allocated into three groups: group A (n = 72) received a 10-d bismuth pectin quadruple therapy (20 mg rabeprazole bid, 1000 mg amoxicillin bid, 100 mg bismuth pectin qid, and 500 mg levofloxacin qd); group B (n = 72) received the sequential therapy (20 mg omeprazole bid, 1000 mg amoxicillin bid, in 5 d, followed by 20 mg omeprazole bid, 500 mg tinidazole bid, 500 mg clarithromycin bid, for another 5 d); group C (n = 71) received a standard 1-wk triple therapy (20 mg omeprazole bid, 1000 mg amoxicillin bid, 500 mg clarithromycin bid). After all these treatments, 20 mg omeprazole bid was administrated for 3 wk. H. pylori status was assessed by histology, 13C-urea breath test and rapid urease test at baseline and 4-6 wk after completion of treatment. Ulcer cicatrization was assessed by gastroscopy. chi(2) test (P < 0.05) was used to compare the eradication rates and ulcer cicatrisation rates among the three groups.


RESULTS
The eradication rate was 83.33% (60/72) in group A, 88.89% (64/72) in group B, and 80.56% (58/71) in group C. The ulcer cicatrisation rate was 86.44% (51/59) in group A, 90.16% (55/61) in group B, and 84.91% (45/53) in group C. The sequential therapy yielded a higher eradication rate and ulcer cicatrisation rate than the standard triple and bismuth pectin quadruple therapies. Statistically, the eradication rate of group B was significantly different from groups A and C (P < 0.05), but the difference of ulcer cicatrisation rate and side effects was not statistically significant among the three groups (P > 0.05). The three protocols were generally well tolerated.


CONCLUSIONS
The sequential therapy has achieved a significantly higher eradication rate, and is a more suitable first-line alternative protocol for anti-H. pylori infection compared with the standard triple and bismuth pectin quadruple therapies.
Gao
Xiao-Zhong
XZ
Division of Gastroenterology, Weihai Municipal Hospital, Weihai 264200, Shandong Province, China. swc1975@hotmail.com
Qiao
Xiu-Li
XL
Song
Wen-Chong
WC
Wang
Xiao-Feng
XF
Liu
Feng
F
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage; D001729:Bismuth / Q000008:administration & dosage* / Q000009:adverse effects; D017291:Clarithromycin / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage; D010368:Pectins / Q000008:administration & dosage; D011446:Prospective Studies
D000658:Amoxicillin; D010368:Pectins; D017291:Clarithromycin; D009853:Omeprazole; D001729:Bismuth
J Clin Gastroenterol. 2002 Oct;35(4):315-20
12352294
Aliment Pharmacol Ther. 2004 Feb 15;19(4):407-14
14871280
Am J Gastroenterol. 2003 Dec;98(12):2621-6
14687807
Aliment Pharmacol Ther. 2003 Jun 1;17(11):1381-7
12786632
Aliment Pharmacol Ther. 1999 Feb;13(2):163-8
10102945
Aliment Pharmacol Ther. 2003 Apr;17(8):1065-74
12694089
Aliment Pharmacol Ther. 1999 Apr;13(4):483-7
10215732
J Clin Gastroenterol. 2004 Apr;38(4):326-31
15087691
Aliment Pharmacol Ther. 2001 May;15(5):613-24
11328254
Can J Gastroenterol. 2003 Jun;17 Suppl B:18B-20B
12845346
Am J Gastroenterol. 1999 May;94(5):1197-9
10235192
Dig Liver Dis. 2001 Dec;33(9):788-94
11838615
Aliment Pharmacol Ther. 1999 Apr;13(4):489-96
10215733
Aliment Pharmacol Ther. 1998 Apr;12(4):383-8
9690730
Br Med Bull. 1998;54(1):207-16
9604444
Aliment Pharmacol Ther. 2002 Jul;16(7):1269-75
12144576
J Med Microbiol. 2000 May;49(5):415-418
10798553
Am J Gastroenterol. 2000 Dec;95(12):3393-8
11151867
Am J Gastroenterol. 2010 Jan;105(1):65-73
19755966
Aliment Pharmacol Ther. 2005 Jun 15;21(12):1419-24
15948808
Can J Gastroenterol. 2004 Sep;18(9):547-54
15457293
Gastroenterology. 2005 Nov;129(5):1414-9
16285942
Aliment Pharmacol Ther. 2000 Jun;14(6):715-8
10848654
Aliment Pharmacol Ther. 2000 Nov;14(11):1529-35
11069326
Digestion. 1997;58(3):211-7
9243115
J Clin Gastroenterol. 2004 Apr;38(4):322-5
15087690
J Antimicrob Chemother. 2007 Apr;59(4):783-5
17329269
World J Gastroenterol. 2004 Jun 1;10(11):1656-8
15162544
Helicobacter. 1999 Jun;4(2):106-12
10382124
Gut. 2007 Oct;56(10):1353-7
17566020
Am J Gastroenterol. 2008 Sep;103(9):2220-3
18564109
Lancet. 1992 Jul 25;340(8813):239
1353155
Aliment Pharmacol Ther. 2002 Feb;16(2):167-80
11860399
Aliment Pharmacol Ther. 1999 May;13(5):667-73
10233191
Dig Liver Dis. 2000 Dec;32 Suppl 3:S190-2
11245292