title: Efficacy, tolerability, and factors affecting the efficacy of the sequential therapy in curing Helicobacter pylori infection in clinical setting.
abstract: BACKGROUND
  Sequential therapy is currently suggested as first-line therapy in curing Helicobacter pylori infection, but results coming from its use in clinical practice are scarce. We evaluated the efficacy of this therapy regimen in our current clinical practice.
  
  
  METHODS
  A retrospective study was conducted on 437 consecutive dyspeptic patients with proven H. pylori infection. Patients received a 10-day sequential therapy with proton pump inhibitor (PPI) plus amoxicillin 1 g for the first 5 days, followed by PPI, clarithromycin 500 mg, and tinidazole 500 mg for the remaining 5 days (all twice daily) plus PPI every day for further 4 weeks in case of active peptic ulcer or severe gastritis detected at endoscopy. One month after conclusion of therapy, endoscopy was performed in those patients for whom the examinations were clinically relevant. The remaining patients were checked by C-urea breath test.
  
  
  RESULTS
  Three-hundred ninety-eight patients (91.08%; 95% confidence interval [CI], 87.91%-93.50%) were fully compliant, 19 patients (4.35%; 95% CI, 2.71%-6.83%) took less than 80% of the prescribed drugs, 11 patients (2.52%; 95% CI, 1.33%-4.60%) were withdrawn because of side effects, and 9 patients (2.06%; 95% CI, 1.01%-4.01%) were lost to follow-up. The H. pylori eradication was obtained in 395 (90.39%, 95% C.I. 87.14% to 92.91%) of 437 and in 362 of 437 (82.84%, 95% C.I. 78.90% to 86.19%) as per-protocol and intention-to-treat analyses, respectively.
  
  
  CONCLUSIONS
  Sequential regimen seems to be a valid therapeutic strategy for the management of H. pylori infection in clinical practice.
authors: Gastroenterology Service, ASL BAT, Andria (BAT), Italy. antotursi@tiscali.it
authors: Antonio
authors: A
authors: Tursi
authors: Walter
authors: W
authors: Elisei
authors: Gianmarco
authors: G
authors: Giorgetti
authors: Marcello
authors: M
authors: Picchio
authors: Giovanni
authors: G
authors: Brandimarte
mesh_terms: D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage; D017291:Clarithromycin / Q000008:administration & dosage; D004359:Drug Therapy, Combination / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000378:metabolism*; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D012189:Retrospective Studies; D014011:Tinidazole / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors; D014011:Tinidazole; D000658:Amoxicillin; D017291:Clarithromycin