title: Concomitant therapy achieved the best eradication rate for Helicobacter pylori among various treatment strategies.
abstract: OBJECTIVE
  To compare the Helicobacter pylori (H. pylori) eradication rate of clarithromycin-based triple therapy, metronidazole-based triple therapy, sequential therapy and concomitant therapy.
  
  
  METHODS
  A total of 680 patients infected with H. pylori were divided into 4 groups and each group was treated with a different eradication therapy. Clarithromycin-based triple therapy was applied to the first group [rabeprazole, amoxicillin and clarithromycin (PAC) group: proton pump inhibitor (PPI), amoxicillin, clarithromycin], whereas the second group was treated with metronidazole-based triple therapy [rabeprazole, amoxicillin and metronidazole (PAM) group: PPI, amoxicillin, metronidazole]. The third group was treated with rabeprazole and amoxicillin, followed by rabeprazole, clarithromycin and metronidazole (sequential group). The final group was simultaneously treated with rabeprazole, amoxicillin clarithromycin and metronidazole (concomitant therapy group). In the case of a failure to eradicate H. pylori, second-line quadruple and third-line eradication therapies were administered.
  
  
  RESULTS
  The per protocol (PP) analysis was performed on 143, 139, 141 and 143 patients in the PAC, PAM, sequential and concomitant groups, respectively. We excluded patients who did not receive a C(13)-urea breath test (22, 20, 23 and 22 patients, respectively) and patients with less than an 80% compliance level (5, 11, 6 and 5 patients, respectively). The eradication rates were 76.2% (109/143) in the PAC group, 84.2% (117/139) in the PAM group, 84.4% (119/141) in the sequential group and 94.4% (135/143) in the concomitant group (P = 0.0002). All 14 patients who failed second-line therapy were treated with third-line eradication therapy. Among these 14 patients, 6 infections were successfully eradicated with the third-line therapy. Both PP and intention-to-treat analysis showed an eradication rate of 42.9% (6/14). In the PAC group, 3 of 4 patients were successfully cured (3/4, 75%); 2 of 2 patients in the PAM group (2/2, 100%) and 1 of 5 patients in the sequential group (1/5, 20%) were also cured. In the concomitant group, all 3 patients failed (0/3, 0%).
  
  
  CONCLUSIONS
  The eradication rate for the concomitant therapy was much higher than those of the standard triple therapy or sequential therapy (ClinicalTrials.gov number NCT01922765).
authors.affiliation: Hyun Jeong Lee, Jin Il Kim, Jin Soo Lee, Eun Jung Jun, Jung-Hwan Oh, Dae Young Cheung, Woo Chul Chung, Byung-Wook Kim, Sung Soo Kim, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 150-713, South Korea.
authors.forename: Hyun Jeong
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Hyun Jeong Lee, Jin Il Kim, Jin Soo Lee, Eun Jung Jun, Jung-Hwan Oh, Dae Young Cheung, Woo Chul Chung, Byung-Wook Kim, Sung Soo Kim, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 150-713, South Korea.
authors.forename: Jin Il
authors.initials: JI
authors.lastname: Kim
authors.affiliation: Hyun Jeong Lee, Jin Il Kim, Jin Soo Lee, Eun Jung Jun, Jung-Hwan Oh, Dae Young Cheung, Woo Chul Chung, Byung-Wook Kim, Sung Soo Kim, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 150-713, South Korea.
authors.forename: Jin Soo
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Hyun Jeong Lee, Jin Il Kim, Jin Soo Lee, Eun Jung Jun, Jung-Hwan Oh, Dae Young Cheung, Woo Chul Chung, Byung-Wook Kim, Sung Soo Kim, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 150-713, South Korea.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Jun
authors.affiliation: Hyun Jeong Lee, Jin Il Kim, Jin Soo Lee, Eun Jung Jun, Jung-Hwan Oh, Dae Young Cheung, Woo Chul Chung, Byung-Wook Kim, Sung Soo Kim, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 150-713, South Korea.
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Oh
authors.affiliation: Hyun Jeong Lee, Jin Il Kim, Jin Soo Lee, Eun Jung Jun, Jung-Hwan Oh, Dae Young Cheung, Woo Chul Chung, Byung-Wook Kim, Sung Soo Kim, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 150-713, South Korea.
authors.forename: Dae Young
authors.initials: DY
authors.lastname: Cheung
authors.affiliation: Hyun Jeong Lee, Jin Il Kim, Jin Soo Lee, Eun Jung Jun, Jung-Hwan Oh, Dae Young Cheung, Woo Chul Chung, Byung-Wook Kim, Sung Soo Kim, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 150-713, South Korea.
authors.forename: Woo Chul
authors.initials: WC
authors.lastname: Chung
authors.affiliation: Hyun Jeong Lee, Jin Il Kim, Jin Soo Lee, Eun Jung Jun, Jung-Hwan Oh, Dae Young Cheung, Woo Chul Chung, Byung-Wook Kim, Sung Soo Kim, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 150-713, South Korea.
authors.forename: Byung-Wook
authors.initials: BW
authors.lastname: Kim
authors.affiliation: Hyun Jeong Lee, Jin Il Kim, Jin Soo Lee, Eun Jung Jun, Jung-Hwan Oh, Dae Young Cheung, Woo Chul Chung, Byung-Wook Kim, Sung Soo Kim, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 150-713, South Korea.
authors.forename: Sung Soo
authors.initials: SS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000009:adverse effects / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001944:Breath Tests; D017291:Clarithromycin / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000188:drug therapy / Q000382:microbiology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005756:Gastritis / Q000188:drug therapy / Q000382:microbiology; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000472:pathogenicity; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008795:Metronidazole / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D064750:Rabeprazole / Q000009:adverse effects / Q000627:therapeutic use*; D056910:Republic of Korea; D013276:Stomach Ulcer / Q000188:drug therapy / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D064750:Rabeprazole; D000658:Amoxicillin; D017291:Clarithromycin
keywords: Concomitant therapy; Drug resistance; Eradication; Helicobacter pylori; Sequential therapy