Antimicrobial resistance has decreased eradication rates for Helicobacter pylori infection worldwide.
Dr Dino Vaira and colleagues from Italy evaluated 300 patients with dyspepsia or peptic ulcers at 2 hospitals between 2003 and 2006.
The team determined whether sequential treatment eradicates H pylori infection is better than standard triple-drug therapy for adults with dyspepsia or peptic ulcers.
|Sequential therapy contained tinidazole
not found in standard therapy|
|Annals of Internal Medecine|
The team performed 13C-urea breath test, upper endoscopy, histologic evaluation, rapid urease test, and bacterial culture.
The research team assessed antibiotic resistance.
The team gave patients a 10-day sequential regimen of 40 mg of pantoprazole, 1 g of amoxicillin and placebo.
The regimens were each administered twice daily for the first 5 days.
The team then administered 40 mg of pantoprazole, 500 mg of clarithromycin, and 500 mg of tinidazole, each administered twice daily for the remaining 5 days.
In addition, a standard 10-day therapy of 40 mg of pantoprazole, 500 mg of clarithromycin, and 1 g of amoxicillin was administered twice daily.
The researchers found that the eradication rate achieved with the sequential regimen was greater than with the standard treatment.
Sequential therapy was significantly more effective in patients with clarithromycin-resistant strains.
The research team observed that the incidence of major and minor side effects did not differ between therapy groups.
The team noted that 1 patient in the standard therapy group discontinued treatment because of side effects.
The team found that follow-up was incomplete in 5% and 3% patients in the sequential therapy and standard therapy groups, respectively.
The results may not be generalizable to other countries.
The researchers noted that sequential therapy may be more effective because it includes 1 additional antibiotic, tinidazole, that is not contained in standard therapy.
Dr Vaira's team concluded, “Sequential therapy is statistically significant compared with standard therapy for eradicating H pylori infection.”
“Sequential therapy is significantly more effective in patients with clarithromycin-resistant strains.”
“Side effects are similar with both treatment regimens and are rarely severe enough to cause discontinuation of therapy.”