Comparison of three different regimens against Helicobacter pylori as a first-line treatment: A randomized clinical trial

Abstract

Treatments with bismuth-containing quadruple therapy (QT), sequential therapy (ST), or concomitant therapy (CT) have been proposed as empirical first-line regimens for Helicobacter pylori. We compared the efficacy and tolerability of 10 days bismuth-containing quadruple QT, 10 days ST, and 10 days CT with as first-line treatments for H. pylori in a randomized crossover study. The subjects were randomly divided into three groups. The first 130 patients were treated with rabeprazole, bismuth potassium citrate, metronidazole, and tetracycline for 10 days. The second 130 patients in the sequential group were treated with rabeprazole and amoxicillin for 5 days, and then rabeprazole, clarithromycin, and metronidazole for an additional 5 days. The last 130 patients in the concomitant group were treated with rabeprazole, amoxicillin, clarithromycin, and metronidazole for 10 days. H. pylori eradication was confirmed by urea breath test at 6 weeks. The primary outcome was eradication rates of first-line treatment by intention to treat and per protocol (PP) analyzes. There was no difference between the average ages and the male/female ratio of the groups. The PP analysis was performed on 121, 119, and 118 patients in the QT, ST, and CT groups, respectively. In the PP analysis, the successful eradication 94.2% (114/121), 95.0% (113/119), and 95.8% (113/118) the QT, ST, and CT groups, respectively. There was no significant difference among the three groups (p = 0.86). 10 days QT, ST, and CT are highly effective as empirical first-line therapies for H. pylori in the region with high clarithromycin resistance.

Ten-Day Concomitant, 10-Day Sequential, and 7-Day Triple Therapy as First-Line Treatment for Helicobacter pylori Infection: A Nationwide Randomized Trial in Korea

“…Recent studies have carried out randomized trials including bismuth-containing quadruple therapy, widely used as a second-line eradication therapy 23,35. In this trial, we compared all three currently used therapeutic regimens: 7d-TT, 10d-CT, and 10d-ST.…”

“…ST was effective in case of clarithromycin resistance,39 metronidazole resistance,40 and even resistance to both clarithromycin and metronidazole 39. ST was reported to be more effective than 7d-TT in many Asian countries 35. However, the shortcoming of ST is that medications were changed during treatment and patients found it difficult to take them 32.…”

Sequential Therapy for First-Line Helicobacter pylori Eradication: 10- or 14-Day Regimen?

“…Curing H. pylori infection still remains a challenge in clinical practice. The 10-day sequential therapy, suggested as first-line therapy in the current Italian guidelines [3], has been proven to be effective in several countries, achieving eradication rates as high as 91.1%-93.7% in Italy [7,11], 92.5-95% in Turkey [12,13], 94.2% in Slovenia [14], 90% in Portugal [15], 90% in Belgium [16], 95.9% in Israel [17], 94% in Thailand [18], 91.9% in Taiwan [19], 90.3% in Singapore [20], and 88.6% in the United Arab Emirates [21]. In detail, the 10-day sequential therapy was found to be equally effective -but cheaper -than J Gastrointestin Liver Dis, March 2019 Vol.…”

Clinical Outcomes of Standard Triple Therapy Plus Probiotics or Concomitant Therapy for Helicobacter pylori Infection

“…Previous studies have suggested that CT is more effective than STT for H. pylori eradication in areas where antibiotic resistance is high. 9 , 15 In some countries, including South Korea, many clinicians prescribe CT for H. pylori eradication. However, CT has more side effects than STT, and some studies showed that probiotics were effective for the eradication of H. pylori in the Asian population including Korea.…”