Standard proton-pump inhibitor-based therapy for Helicobacter pylori infection fails in up to 25% of patients.
Sequential therapy may be more efficacious.
Dr Nadim Jafri and colleagues from Kentucky, USA compared sequential therapy with standard triple therapy for H pylori infection.
The research team searched MEDLINE, and EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar up to 2007.
PubMed and Ovid were the search engines used.
|H pylori eradication rates were 93% with sequential therapy|
|Annals of Internal Medicine|
The team selected randomized, controlled trials comparing sequential and standard triple therapies in treatment-naïve patients with documented H pylori infection.
There were 3 reviewers who independently assessed trial eligibility and quality, and who extracted data on eradication.
The research team found that the crude rates of H pylori eradication in 10 trials involving 2747 patients were 93% for sequential therapy vs 77% for standard triple therapy.
This gave an absolute risk reduction of 16%.
The median rates of adherence were 97% for both therapies.
The team observed that sequential therapy appeared superior in prespecified sensitivity analyses stratified by trial quality.
This superiority remained on stratifying trials by smoking status, diagnosis, resistance to clarithromycin, imidazoles, or both, duration of triple therapy, and method of diagnosis.
The research team noted that both treatments had similar side effect profiles.
Dr Jafri and team concludes, "Sequential therapy appears superior to standard triple therapy for eradication of H pylori infection."
"If randomized controlled trials in other countries confirm these findings, 10-day sequential therapy could become a standard treatment for H pylori infection in treatment-naïve patients."