title: High eradication rates of Helicobacter pylori infection following sequential therapy: the Israeli experience treating naïve patients.
abstract: BACKGROUND
  Helicobacter pylori eradication rates following triple therapy are decreasing. Cure rates as low as 57%, mainly to claritromycin resistance, have been reported in Israel. Studies performed in Italy have shown eradication rates of 93%, following sequential therapy. Our aim was to evaluate the effect of sequential therapy on eradication rates of H. pylori in naïve Israeli patients.
  
  
  METHODS
  Consecutive patients referred for esophagogastroduodenoscopy with a positive rapid urease test and positive (13) C urea breath test were included. Patients received omeprazole 20 mg bid and amoxicillin 1 g bid for 5 days followed by omeprazole 20 mg bid, clarithromycin 500 mg bid and tinidazole 500 mg bid for the subsequent 5 days. A second (13) C urea breath test was performed at least 4 weeks after completion of therapy. Patients were asked to avoid antibiotics, bismuth compounds or proton pump inhibitor until after the second (13) C urea breath test. Adverse effects were documented by a questionnaire.
  
  
  RESULTS
  One hundred and twenty-four patients (mean age 56.1 ± 12.5 years, 55.6% women) were included; 120/124 (96.8%) completed treatment and performed the second (13) C urea breath test. Two patients (1.6%) were lost to follow-up; 2 (1.6%) were noncompliant with study regulations. One hundred and fifteen patients achieved eradication of H. pylori. The eradication rate was 95.8% by per protocol analysis and 92.7% by intention to treat analysis.
  
  
  CONCLUSIONS
  The sequential regimen attained significantly higher eradication rates in naïve patients than usually reported for conventional triple therapy. Sequential therapy may be an alternative first-line therapy in eradicating H. pylori in Israel.
authors.affiliation: Gastroenterology Unit, Rabin Medical Center, Hasharon Hospital, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Hemda
authors.initials: H
authors.lastname: Schmilovitz-Weiss
authors.forename: Hemda
authors.initials: H
authors.lastname: Schmiloviz-Weiss
authors.forename: Tamar
authors.initials: T
authors.lastname: Shalev
authors.forename: Yelena
authors.initials: Y
authors.lastname: Chechoulin
authors.forename: Zohar
authors.initials: Z
authors.lastname: Levi
authors.forename: Ron
authors.initials: R
authors.lastname: Yishai
authors.forename: Vered
authors.initials: V
authors.lastname: Sehayek-Shabbat
authors.forename: Yaron
authors.initials: Y
authors.lastname: Niv
authors.forename: Haim
authors.initials: H
authors.lastname: Shirin
mesh_terms: D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017291:Clarithromycin / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects / Q000302:isolation & purification / Q000502:physiology; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage; D011446:Prospective Studies; D014011:Tinidazole / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D014011:Tinidazole; D000658:Amoxicillin; D017291:Clarithromycin; D009853:Omeprazole