title: Ten-day sequential therapy is more effective than proton pump inhibitor-based therapy in Korea: a prospective, randomized study.
abstract: OBJECTIVE
  The eradication rate of proton pump inhibitor (PPI)-based triple therapy for Helicobacter pylori (H. pylori) infection has decreased, mainly due to increasing antibiotic resistance, especially against clarithromycin. It has been reported that a 10-day sequential strategy can produce good outcomes. The aim of this prospective study was to assess the efficacy of sequential therapy as the first-line treatment for the eradication of H. pylori in Korea.
  
  
  METHODS
  A total of 116 patients with proven H. pylori infection received 10-day sequential therapy (20 mg rabeprazole and 1 g amoxicillin, twice daily for the first 5 days, followed by 20 mg rabeprazole, 500 mg clarithromycin, and 500 mg metronidazole, twice daily for the remaining 5 days); 130 patients received 7-day triple therapy (20 mg rabeprazole, 500 mg clarithromycin, and 1 g amoxicillin, twice daily for 7 days). Eradication was evaluated by the (13) C-urea breath test, 4 weeks after the completion of treatment. Compliance and adverse events were assessed.
  
  
  RESULTS
  The eradication rates of 10-day sequential therapy and PPI-based triple therapy were 79.3% (92/116) and 63% (82/130) by intention-to-treat analysis, respectively (P = 0.005), and 81.9% (91/111) and 64.5% (82/127) by per protocol analysis, respectively (P = 0.003). Mild adverse events occurred in both therapy groups (27.5% vs 23.8%), but both treatments were well tolerated.
  
  
  CONCLUSIONS
  The eradication rate of the 10-day sequential therapy regimen was significantly higher than that of PPI-based triple therapy in the Korean population. Ten-day sequential therapy might be effective as a first-line treatment for H. pylori infection in Korea.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hong Sang
authors.initials: HS
authors.lastname: Oh
authors.forename: Dong Ho
authors.initials: DH
authors.lastname: Lee
authors.forename: Ji Yeon
authors.initials: JY
authors.lastname: Seo
authors.forename: Yu Ri
authors.initials: YR
authors.lastname: Cho
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.forename: Sook Hyang
authors.initials: SH
authors.lastname: Jeoung
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Kim
authors.forename: Jin Hyeok
authors.initials: JH
authors.lastname: Hwang
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Park
authors.forename: Sang Hyub
authors.initials: SH
authors.lastname: Lee
authors.forename: Cheol Min
authors.initials: CM
authors.lastname: Shin
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Cho
authors.forename: Hyun Chae
authors.initials: HC
authors.lastname: Jung
authors.forename: In Sung
authors.initials: IS
authors.lastname: Song
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage / Q000009:adverse effects; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects; D001944:Breath Tests; D016009:Chi-Square Distribution; D017291:Clarithromycin / Q000008:administration & dosage / Q000009:adverse effects; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000379:methods; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D055118:Medication Adherence; D008795:Metronidazole / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D064750:Rabeprazole; D056910:Republic of Korea
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D064750:Rabeprazole; D000658:Amoxicillin; D017291:Clarithromycin