title: Is there a benefit to extending the duration of Helicobacter pylori sequential therapy to 14 days?
abstract: OBJECTIVE
  Ten-day sequential therapy with a proton-pump inhibitor (PPI) and amoxicillin followed by a PPI, clarithromycin, and an imidazole typically achieves Helicobacter pylori (H. pylori) eradication rates between 90 and 94% (i.e., Grade B success). It has been suggested that prolonging the duration of therapy might improve the treatment success. We tested whether prolonging treatment duration to 14-days would improve the results to 95% or greater eradication.
  
  
  METHODS
  This was a multi-center, single site, pilot study in which H. pylori-infected patients received a 14-day sequential therapy (esomeprazole and amoxicillin for 7 days followed by esomeprazole, clarithromycin, and metronidazole for 7 days). H. pylori status was assessed 8 weeks after therapy. Success was defined as achieving 95% or greater eradication by per-protocol (PP) analysis.
  
  
  RESULTS
  One hundred and twenty-three subjects received the 14-day sequential therapy. The eradication rate was 93.9% (95% confidence interval [CI], 89.5-98.3%) by PP and 91.9% (95% CI, 87.1-96.7%) by intention-to-treat analysis. Adverse events were experienced by 21.1%; compliance of 90% or greater was 95.9%.
  
  
  CONCLUSIONS
  Extending sequential therapy to 14 days did not result in improving the treatment outcome to 95% or greater.
authors: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung, Taiwan. williamhsup@yahoo.com.tw
authors: Ping I
authors: PI
authors: Hsu
authors: Deng-Chyang
authors: DC
authors: Wu
authors: Jeng-Yih
authors: JY
authors: Wu
authors: David Y
authors: DY
authors: Graham
mesh_terms: D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000379:methods*; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin