title: Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: a prospective randomized study.
abstract: OBJECTIVE
  Eradication rates following standard triple therapy for Helicobacter pylori infection are declining. Recent studies, conducted in a number of countries, have shown that sequential therapy for H. pylori infection yields high cure rates.
  
  
  OBJECTIVE
  To compare the efficacy and tolerability of a sequential regimen as a first-line treatment of H. pylori infection with a standard triple treatment regime in Morocco.
  
  
  METHODS
  A total of 281 naive H. pylori-infected patients, confirmed by histological examination, were assigned randomly to one of two treatment groups: standard triple therapy [omeprazole (20 mg bid) + amoxicillin (1 g bid) + clarithromycin (500 mg bid) for 7 days] or sequential therapy [omeprazole (20 mg bid) + amoxicillin (1 g bid) for 5 days, followed by omeprazole (20 mg bid) + tinidazole (500 mg bid) + clarithromycin (500 mg bid) for an additional 5 days]. H. pylori eradication was checked 4-6 weeks after treatment initiation by using a ¹³C-urea breath test. Compliance and adverse events were assessed.
  
  
  RESULTS
  The two groups did not differ significantly in gender, age, previous disease history, endoscopic and histological features and smoking. The intention-to-treat and per-protocol eradication rates were 65.9 and 71 % in the standard triple therapy group, and 82.8 and 89.9 % in the sequential therapy group, respectively. The eradication rate was significantly higher in the sequential therapy group than in the standard triple therapy group (p < 0.001), There was no statistically significant difference in compliance (97.5 vs. 96.3 %) and incidence of side-effects (27.5 vs. 27.9 %) between the two groups.
  
  
  CONCLUSIONS
  Based on our results, we conclude that for eradication of H. pylori infection, the 10-day sequential therapy is more effective than the standard triple therapy and is equally tolerated. These results confirm those of other studies in other countries.
authors.affiliation: Department of Gastroenterology II, Mohammed V Teaching Military Hospital, Rabat, Morocco.
authors.forename: Hassan
authors.initials: H
authors.lastname: Seddik
authors.forename: Samir
authors.initials: S
authors.lastname: Ahid
authors.forename: Tarek
authors.initials: T
authors.lastname: El Adioui
authors.forename: Fatim-Zohra
authors.initials: FZ
authors.lastname: El Hamdi
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hassar
authors.forename: Redouane
authors.initials: R
authors.lastname: Abouqal
authors.forename: Yahia
authors.initials: Y
authors.lastname: Cherrah
authors.forename: Ahmed
authors.initials: A
authors.lastname: Benkirane
mesh_terms: 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; D017291:Clarithromycin / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D000658:Amoxicillin; D017291:Clarithromycin; D009853:Omeprazole