title: Comparison of hybrid and sequential therapies for Helicobacter pylori eradication in Iran: a prospective randomized trial.
abstract: BACKGROUND
  The eradication of Helicobacter pylori has been always a concern. In the present study, we aimed to compare two novel treatments in Iran.
  
  
  METHODS
  Four hundred and twenty patients with peptic ulcer and naïve H. pylori infection were randomized in the study. Two hundred and ten patients received hybrid therapy: pantoprazole 40 mg/b.i.d. and amoxicillin 1 g/b.i.d. for 14 days plus 500 mg clarithromycin and 500 mg tinidazole, both twice daily for the last 7 days. The other 210 patients received sequential therapy: 40 mg pantoprazole/b.i.d. for 10 days and 1 g amoxicillin/b.i.d. for the first 5 days, followed by 500 mg clarithromycin/b.i.d. and 500 mg tinidazole/b.i.d. for the last 5 days. C¹⁴-urea breath test was performed 8 weeks after the treatment.
  
  
  RESULTS
  Three hundred and ninety-six patients (197 patients in the hybrid group and 199 patients in the sequential group) completed the study. The compliance rates were 96.7 and 98.6% for the two groups, respectively. The intention-to-treat eradication rate was 89.5% (95% CI = 85.4-93.6) for the hybrid group and 76.7% (95% CI = 71-82.4) for the sequential group (p = .001), and the per-protocol eradication rates were 92.9% (95% CI = 89.2-96.5) and 79.9% (95% CI = 74.1-85.4) for the hybrid and sequential groups (p = .001), respectively. Severe adverse effects were observed in 2.4% of patients in the hybrid group and 3.8% of those in the sequential group.
  
  
  CONCLUSIONS
  According to our results, sequential regimen does not seem to be an appropriate therapy for H. pylori eradication in the Iranian population, whereas hybrid therapy showed to be more effective. However, considering the high cost of clarithromycin in Iran, we recommend further studies to compare hybrid therapy with bismuth-containing regimens or to assess the effects of hybrid therapies with periods shorter than 14 days.
authors.affiliation: Department of Gastroenterology, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Sardarian
authors.forename: Hafez
authors.initials: H
authors.lastname: Fakheri
authors.forename: Vahid
authors.initials: V
authors.lastname: Hosseini
authors.forename: Tarang
authors.initials: T
authors.lastname: Taghvaei
authors.forename: Iradj
authors.initials: I
authors.lastname: Maleki
authors.forename: Marjan
authors.initials: M
authors.lastname: Mokhtare
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D017291:Clarithromycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D000077402:Pantoprazole; D010437:Peptic Ulcer / Q000188:drug therapy / Q000382:microbiology; D011446:Prospective Studies; D014011:Tinidazole / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D014011:Tinidazole; D000658:Amoxicillin; D000077402:Pantoprazole; D017291:Clarithromycin