title: Ten-day triple therapy versus sequential therapy versus concomitant therapy as first-line treatment for Helicobacter pylori infection.
abstract: OBJECTIVE
  Clarithromycin-based triple therapy (TT) is the first-line treatment for Helicobacter pylori infection in Singapore. There is awareness that TT may no longer be effective due to increased clarithromycin resistance rates. Sequential therapy (ST) and concomitant therapy (CT) are alternative treatment regimens. This study aimed to compare the efficacy of 10-day TT, ST, and CT as first-line treatment for H. pylori infection.
  
  
  METHODS
  A randomized study conducted in a teaching hospital. Patients aged 21 years and older with newly diagnosed H. pylori infection were randomized to 10-day TT, ST, or CT. Treatment outcome was assessed by 13-carbon urea breath test at least 4 weeks after therapy. Intention to treat (ITT), modified ITT (MITT), and per protocol (PP) analyses of the eradication rates were performed.
  
  
  RESULTS
  A total of 462 patients were enrolled (ST: 154; TT 155; CT 153). Patient demographics were similar. Eradication rates for ST versus TT versus CT: ITT analysis: 84.4% versus 83.2% versus 81.7% (P = not significant [NS]); MITT analysis: 90.3% versus 92.1% versus 94.7% (P = NS); PP analysis: 94.1% versus 92.8% versus 95.4% (P = NS). Antibiotic resistance rates for amoxicillin, clarithromycin, and metronidazole were 4.7%, 17.9%, and 48.1%, respectively. Dual clarithromycin and metronidazole resistance occurred in 7.5%. Dual resistance and lack of compliance were predictors of treatment failure.
  
  
  CONCLUSIONS
  TT, ST, and CT all achieved eradication rates above 80% on ITT and above 90% on MITT and PP analyses. Dual resistance and lack of compliance were predictors of treatment failure (clinicaltrials.gov: NCT02092506).
authors: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors: Tiing Leong
authors: TL
authors: Ang
authors: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors: Kwong Ming
authors: KM
authors: Fock
authors: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors: Mingjun
authors: M
authors: Song
authors: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors: Daphne
authors: D
authors: Ang
authors: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors: Andrew Boon Eu
authors: AB
authors: Kwek
authors: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors: Jeannie
authors: J
authors: Ong
authors: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors: Jessica
authors: J
authors: Tan
authors: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors: Eng Kiong
authors: EK
authors: Teo
authors: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors: Subbiah
authors: S
authors: Dhamodaran
mesh_terms: D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage* / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology; D017291:Clarithromycin / Q000008:administration & dosage* / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D005260:Female; D005756:Gastritis / Q000188:drug therapy*; D016481:Helicobacter Infections; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage* / Q000494:pharmacology; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin
keywords: H. pylori; antibiotic resistance; treatment