title: Efficacy and safety of sequential therapy versus standard triple therapy in Helicobacter pylori eradication in Kashmir India: a randomized comparative trial.
abstract: BACKGROUND
  Increasing resistance against Helicobacter pylori has resulted in reduced eradication rates.
  
  
  OBJECTIVE
  This study aims to determine whether eradication rates for H. pylori infection with sequential therapy is better than standard triple therapy.
  
  
  METHODS
  Patients with endoscopy documented peptic ulcer and H. pylori infection confirmed by histology and rapid urease test.
  
  
  METHODS
  Patients were randomized into two groups; 134 received standard triple therapy (pantoprazole 40 mg, clarithromycin 500 mg and amoxicillin 1 g each administered twice daily) for 10 days and 138 received sequential regimen (pantoprazole 40 mg plus amoxicillin 1 g twice daily for 5 days followed by 40 mg pantoprazole, 500 mg clarithromycin, and 500 mg tinidazole each administered twice daily for 5 days). Eradication was confirmed by histology and rapid urease test. Compliance and adverse effects were determined by the recovery of empty medicine strips and questioning.
  
  
  RESULTS
  The eradication rates with sequential therapy were significantly greater than with standard therapy on both intention-to-treat analysis (76.0 % vs. 61.9 %, p = 0.005; difference, 14.1 % [95 % CI, 6.5-19 %] and per protocol analysis (84.6 % vs. 67.4 %, p = 0.002; difference, 17.2 % [95 % CI, 8.5-23.5 %]). The incidence of side effects did not differ between the two therapy groups. One patient in standard therapy discontinued treatment due to side effects.
  
  
  CONCLUSIONS
  Cultures were not performed. Loss to follow up was 5.2 % in standard therapy and 6.5 % in sequential therapy.
  
  
  CONCLUSIONS
  Sequential therapy was significantly more effective than standard therapy for eradicating H. pylori infection in peptic ulcer disease in Asian patients. Side effects were similar.
authors.affiliation: Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar 190 011, India.
authors.forename: Gul
authors.initials: G
authors.lastname: Javid
authors.forename: Showkat Ali
authors.initials: SA
authors.lastname: Zargar
authors.forename: Khurshid
authors.initials: K
authors.lastname: Bhat
authors.forename: Bashir Ahmad
authors.initials: BA
authors.lastname: Khan
authors.forename: Ghulam Nabi
authors.initials: GN
authors.lastname: Yatoo
authors.forename: Ghulam Mohamad
authors.initials: GM
authors.lastname: Gulzar
authors.forename: Altaf Hussain
authors.initials: AH
authors.lastname: Shah
authors.forename: Jaswinder Singh
authors.initials: JS
authors.lastname: Sodhi
authors.forename: Mushtaq Ahmad
authors.initials: MA
authors.lastname: Khan
authors.forename: Abid
authors.initials: A
authors.lastname: Shoukat
authors.forename: Riyaz U
authors.initials: RU
authors.lastname: Saif
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents