Sequential Therapy versus Triple Therapy for the First Line Treatment of Helicobacter pylori in Korea: A Nationwide Randomized Trial.
OBJECTIVE
Eradication of Helicobacter pylori infection with standard triple therapy (TT) has declined primarily because of increased antibiotic resistance. Sequential therapy (ST) has been suggested as an alternative to TT for the first-line treatment of H. pylori. The purpose of this study was to compare the efficacy of ST with TT.


METHODS
This was a multicenter, randomized open-label trial performed at nine centers in Korea. Patients with H. pylori infection were randomly assigned to receive either 7 day TT or 10 day ST. Eradication rates, drug compliance, and adverse events were compared among the two regimens.


RESULTS
A total of 601 patients were enrolled between March 2011 and September 2014. The intention-to-treat eradication rates were 70.8% for TT and 82.4% for ST (p=0.001). The corresponding per protocol eradication rates were 76.9% and 88.8% for TT and ST, respectively (p=0.000). There were no statistically significant differences between the two regimens with respect to drug compliance and adverse events.


CONCLUSIONS
ST achieved better eradication rates than TT as a first-line therapy for H. pylori eradication in Korea.
Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea.
Joon Sung
JS
Kim
Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea.
Byung-Wook
BW
Kim
Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
Su Jin
SJ
Hong
Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
Jin Il
JI
Kim
Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea.
Ki-Nam
KN
Shim
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Jie-Hyun
JH
Kim
Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
Gwang Ho
GH
Baik
Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
Sang Wook
SW
Kim
Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
Hyun Joo
HJ
Song
Department of Internal Medicine, Inje University Busan Paik Hospital, Inje Univeristy College of Medicine, Busan, Korea.
Ji Hyun
JH
Kim
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017291:Clarithromycin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D055118:Medication Adherence; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D056910:Republic of Korea; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin
Disease eradication; Drug resistance; Helicobacter pylori