title: Sequential or concomitant therapy for eradication of Helicobacter pylori infection: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Eradication of Helicobacter pylori (H. pylori) infection with triple therapy (TT) has declined in many countries prompting the search for alternative regimens. Sequential therapy (ST) and concomitant therapy (CT) have been suggested as first-line regimens in areas of high clarithromycin resistance. We performed a meta-analysis to compare the eradication rates of CT with ST for H. pylori.
  
  
  METHODS
  A comprehensive literature search for studies comparing the efficacy of CT with ST was performed. Dichotomous data were pooled to obtain the odds ratio (OR) of the eradication rate with 95% confidence intervals (CIs). The eradication rates were considered both on an intention-to-treat (ITT) and on a per-protocol (PP) bases.
  
  
  RESULTS
  A total of 7 studies provided data on 2412 adult patients. Pooled estimates of the studies revealed no significant differences between CT and ST. The pooled OR was 1.116 (95% CI: 0.795-1.567, P = 0.526) for ITT analysis and 1.153 (95% CI: 0.793-1.677, P = 0.455) for PP analysis. There was no difference in the rate of adverse events (OR: 1.229, 95% CI: 0.971-1.556, P = 0.086) and compliance (OR: 0.945, 95% CI: 0.722-1.237, P = 0.681) between the two regimens. Subgroup analysis was performed to compare CT of 10 days and 5 days with ST of 10 days. The pooled OR was 1.518 for CT of 10 days and 0.636 for CT of 5 days.
  
  
  CONCLUSIONS
  CT regimens did not achieve higher eradication rates compared with the ST regimen. The adverse events and adherence to medications were not different between the two regimens.
authors: Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.
authors: Joon Sung
authors: JS
authors: Kim
authors: Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.
authors: Sung Min
authors: SM
authors: Park
authors: Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.
authors: Byung-Wook
authors: BW
authors: Kim
mesh_terms: D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D017291:Clarithromycin / Q000008:administration & dosage; D016206:Databases, Bibliographic; D004359:Drug Therapy, Combination; D005756:Gastritis / Q000188:drug therapy* / Q000382:microbiology*; D016481:Helicobacter Infections; D016480:Helicobacter pylori; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D064067:Rho Guanine Nucleotide Exchange Factors / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: C577228:ARHGEF5 protein, human; D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D064067:Rho Guanine Nucleotide Exchange Factors; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin
keywords: Helicobacter pylori; concomitant therapy; meta-analysis; sequential therapy