Eradication rates with triple therapy for Helicobacter pylori infection have declined to unacceptable levels. 

Sequential therapy is a novel treatment that has shown promise in several controlled trials. 

Dr Luigi Gatta and colleagues from Italy assessed the efficacy of sequential therapy in adults and children compared with that of triple therapy by performing a systematic review and meta-analysis.

The team performed an electronic search of the Cochrane Trial Register, MEDLINE, EMBASE, and abstracts from the major US, European, and Asian gastroenterology conferences.

Randomized controlled trials and controlled clinical trials with a parallel group design comparing the sequential therapy  with a triple therapy lasting at least 7 days were used.

The researchers identified 10 randomized controlled trials that enrolled 3006 adult patients.

The odds ratio for eradication of H. pylori with sequential therapy compared with triple therapy was 3, giving a number needed to treat of 6 favoring sequential therapy .

There was no publication bias. 

The odds ratio for eradication with sequential therapy compared with 10-day triple therapy was 2.9, yielding an number needed to treat of 8, favoring sequential therapy. 

In patients with clarithromycin resistance, the odds ratio for eradication with sequential therapy was 10 compared with triple therapy, but the numbers studied are small. 

The team found 3 randomized controlled trials that enrolled 260 children and adolescents, and the odds ratio for eradication was 2. 

There was no difference in the rate of side effects between the sequential therapy and the triple therapy.

Dr Gatta's team concluded, “Sequential therapy appears to be better than triple therapy in the eradication of H. pylori.” 

“This is a promising therapy, but further trials are needed in other European countries and North America before it can be recommended as a first-line treatment.”