title: Modified sequential therapy regimens for Helicobacter pylori eradication: a systematic review.
abstract: BACKGROUND
  Different modified sequential therapies have been proposed for Helicobacter pylori eradication. However, the efficacy of these regimens is controversial.
  
  
  METHODS
  We performed a systematic review of the literature and pooled-data analysis to assess: (a) the efficacy of different modified sequential therapies for H. pylori eradication, (b) the eradication rates achieved by these regimens as compared to either standard triple therapies or standard sequential regimen when available.
  
  
  RESULTS
  Overall 21 trials met inclusion criteria. The most used modified sequential therapy was the seven plus seven tetracycline-based regimen which achieved an overall 73.3% eradication rate (6 trials). Such therapy was more effective than the 14-day triple therapy (77.2% vs. 63.6%; 3 trials). The most used five plus five levofloxacin-based sequential therapy achieved a 95.8% and 90% cure rates when 250 mg and 500 mg levofloxacin twice daily were used, respectively. These success rates were higher as compared to that of either standard sequential or triple therapies. Other modified sequential therapies did not achieved acceptably high cure rates. Contradictory results emerged from 2 studies assessing the efficacy of a levofloxacin-based sequential regimen as a second-line therapy.
  
  
  CONCLUSIONS
  Both levofloxacin- and tetracycline-based sequential therapies have been proved to be more effective than standard triple therapies, confirming that the 'sequential' administration of drugs is a successful therapeutic procedure for H. pylori infection.
authors.affiliation: Gastroenterology and Digestive Endoscopy, "Nuovo Regina Margherita" Hospital, Rome, Italy. zullo66@yahoo.it
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Francesco
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ridola
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bruzzese
authors.forename: Dino
authors.initials: D
authors.lastname: Vaira
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D064704:Levofloxacin; D015242:Ofloxacin / Q000627:therapeutic use; D013752:Tetracycline / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D015242:Ofloxacin; D013752:Tetracycline