title: Ten-day sequential versus triple therapy for Helicobacter pylori eradication: a prospective, open-label, randomized trial.
abstract: OBJECTIVE
  Increased resistance of Helicobacter pylori to antibiotics has increased the need to develop new first-line treatments for H. pylori. We have prospectively evaluated 10-day sequential versus conventional triple therapy in peptic ulcer patients.
  
  
  METHODS
  One hundred and fifty-nine patients with peptic ulcer diseases were prospectively randomized to receive 10 days of lansoprazole, amoxicillin, and clarithromycin (conventional triple therapy) or 5 days of lansoprazole and amoxicillin followed by 5 days of lansoprazole, clarithromycin, and metronidazole (sequential therapy). Post-treatment H. pylori status was determined by the (13) C-urea breath test. Eradication rates, antibiotic resistance rates by agar dilution method, drug compliance, and side-effects were compared.
  
  
  RESULTS
  The intention-to-treat eradication rates were 75.9% (95% CI 66.5-85.3%, 60/79) in the sequential therapy group and 58.7% (95% CI 47.9-69.5%, 47/80) in the conventional triple therapy group (P = 0.01), while the per-protocol eradication rates were 86.8% (95% CI 78.7-94.8%, 59/68) and 67.6% (95% CI 56.5-78.7%, 46/68) (P = 0.01), respectively. Compliance and side-effects were similar in the two groups. Culture of H. pylori showed that 18.2% were resistant to clarithromycin, 41.9% to metronidazole. Dual resistance to both antibiotics was 9.6%.
  
  
  CONCLUSIONS
  Although 10-day sequential therapy yielded a higher H. pylori eradication rate than 10-day conventional triple therapy, the sequential therapy protocol did not result in a sufficiently satisfactory eradication rate. This might be related to the higher antibiotics resistance rate especially to dual resistance. More effective regimens are needed to overcome antibiotic resistance in Korea.
authors: Department of Internal Medicine, Gachon Graduate School of Medicine, Gil Medical Center, Incheon, Korea. junwonchung@hanmail.net
authors: Jun-Won
authors: JW
authors: Chung
authors: Young Kul
authors: YK
authors: Jung
authors: Yoon Jae
authors: YJ
authors: Kim
authors: Kwang Ahn
authors: KA
authors: Kwon
authors: Jung Ho
authors: JH
authors: Kim
authors: Jong Joon
authors: JJ
authors: Lee
authors: Sung Min
authors: SM
authors: Lee
authors: Ki Baik
authors: KB
authors: Hahm
authors: Sun Mi
authors: SM
authors: Lee
authors: Jin Yong
authors: JY
authors: Jeong
authors: Sung-Cheol
authors: SC
authors: Yun
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage* / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000009:adverse effects; D001944:Breath Tests; D016009:Chi-Square Distribution; D017291:Clarithromycin / Q000008:administration & dosage* / Q000009:adverse effects; D016001:Confidence Intervals; D004334:Drug Administration Schedule; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D057194:Intention to Treat Analysis; D064747:Lansoprazole; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D010349:Patient Compliance; D056910:Republic of Korea; D014508:Urea / Q000032:analysis
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D064747:Lansoprazole; D008795:Metronidazole; D000658:Amoxicillin; D014508:Urea; D017291:Clarithromycin