title: Helicobacter pylori infection: is sequential therapy superior to standard triple therapy? A single-centre Italian study in treatment-naive and non-treatment-naive patients.
abstract: BACKGROUND
  Clarithromycin resistance has decreased the eradication rates of Helicobacter pylori.
  
  
  OBJECTIVE
  To determine whether a 10-day course of sequential therapy (ST) is more effective at eradicating H pylori infection than triple therapy (TT) in the first or second line, and to assess side effects and compliance with therapy.
  
  
  METHODS
  One hundred sixty treatment-naive and 40 non-treatment-naive patients who were positive for H pylori infection by ¹³C-urea breath test or endoscopy were enrolled. Eighty of 160 patients underwent TT, while 80 of 160 underwent ST with omeprazole (20 mg) plus amoxicillin (1 g) twice⁄day for five days, followed by omeprazole (20 mg) with tinidazole (500 mg) twice⁄day and clarithromycin (500 mg) twice⁄day for five consecutive days. H pylori eradication was evaluated by ¹³C-urea breath test no sooner than four weeks after the end of treatment.
  
  
  RESULTS
  Eradication was achieved in 59 of 80 treatment-naive patients treated with TT (74%), in 74 of 80 patients treated with ST (93%), and in 38 of 40 non-treatment-naive patients (95%). Eradication rates in treatment-naive patients with ST were statistically significantly higher than TT (92.5% versus 73.7%; P=0.0015; OR 4.39 [95% CI 1.66 to 11.58]). Mild adverse effects were reported for both regimens.
  
  
  CONCLUSIONS
  ST appears to be a well-tolerated, promising therapy; however, randomized controlled trials with larger and more diverse sample populations are needed before it can be recommended as a first-line treatment.
authors.affiliation: Digestive Endoscopy Unit, Viterbo, Italy. riurgesi@tin.it
authors.forename: R
authors.initials: R
authors.lastname: Urgesi
authors.forename: G
authors.initials: G
authors.lastname: Pelecca
authors.forename: R
authors.initials: R
authors.lastname: Cianci
authors.forename: A
authors.initials: A
authors.lastname: Masini
authors.forename: C
authors.initials: C
authors.lastname: Zampaletta
authors.forename: M E
authors.initials: ME
authors.lastname: Riccioni
authors.forename: R
authors.initials: R
authors.lastname: Faggiani
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000009:adverse effects; D001944:Breath Tests; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination / Q000592:standards; D016099:Endoscopy, Gastrointestinal; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage* / Q000009:adverse effects; D010437:Peptic Ulcer / Q000209:etiology* / Q000382:microbiology; D058996:Quality Improvement; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D009853:Omeprazole