title: Neither 10- nor 14-Day Sequential Treatment is better than Standard Triple Therapy for Helicobacter Pylori Eradication.
abstract: Helicobacter pylori is a bacterial pathogen associated with chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa associated lymphoid tissue lymphoma. Current treatment guidelines support a 7- to 14-day, triple-drug protocol consisting of a proton-pump inhibitor (PPI), clarithromycin, and either amoxicillin or an imidazole. The initial eradication rates for this regimen were 80 to 90%. Nevertheless its effectiveness has declined as the antibiotic resistance to clarithromycin and metronidazole has emerged. In Puerto Rico the reported resistance of H. pylori to clarithromycin is 16% and to metronidazole, 3.7%. Sequential therapy for H. pylori eradication, 5 days of treatment with a PPI and amoxicillin followed by 5 days of treatment with the PPI and 2 other antibiotics (clarithromycin and an imidazole), was introduced as an effective alternate regimen. This is a prospective clinical trial intended to compare the efficacy of first-line, standard 10-day tripledrug therapy with those of both 10- and 14-day sequential therapy in eradicating H. pylori at the San Juan Veterans Affairs Hospital in a population that is naïve to previous treatment.
  
  
  
  This was a prospective, open-label, randomized clinical trial.
  
  
  
  Based on the intention-to-treat analysis, the eradication rate was 83.7% (72 of 86 patients) in the standard triple-therapy group, 80.0% (68/85) in the 10- day sequential-therapy group, and 79.1% (68/86) in the 14-day sequential-therapy group. There were no significant statistical differences between the eradication rates among therapies.
  
  
  
  Sequential-therapy treatment regimens are not better than standard triple therapy for the eradication of H. pylori infection, regardless of the treatment duration.
authors.affiliation: VA Caribbean Healthcare System, San Juan, Puerto Rico.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Warrington
authors.affiliation: VA Caribbean Healthcare System, San Juan, Puerto Rico.
authors.forename: Orlando
authors.initials: O
authors.lastname: López-Román
authors.affiliation: VA Caribbean Healthcare System, San Juan, Puerto Rico.
authors.forename: Rafael
authors.initials: R
authors.lastname: Tirado Montijo
authors.affiliation: VA Caribbean Healthcare System, San Juan, Puerto Rico.
authors.forename: Rafael
authors.initials: R
authors.lastname: Urbina
authors.affiliation: University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico.
authors.forename: Marcia
authors.initials: M
authors.lastname: Cruz-Correa
authors.affiliation: VA Caribbean Healthcare System, San Juan, Puerto Rico.
authors.forename: Doris H
authors.initials: DH
authors.lastname: Toro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017291:Clarithromycin / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D012074:Remission Induction; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin
keywords: Amoxicillin; Breath test; Helicobacter pylori; Proton pump inhibitors; Veterans