The sequential therapy regimen for Helicobacter pylori eradication: a pooled-data analysis

Abstract

Background: Standard triple therapies are the most used treatment in clinical practice. However, a critical fall in the H pylori eradication rate following these therapies has been observed in the last few years. The sequential regimen is a novel, promising therapeutic approach. Objectives: To evaluate the available data on the sequential therapy regimen. Methods: A pooled-data analysis of all studies on the sequential regimen was performed. The eradication rate was calculated according to gastroduodenal pathology, proton pump inhibitor used, antibiotic resistance, as well as setting (paediatric or geriatric patients). Compliance, side effects, and cost implications were also evaluated. Results: Overall, more than 1800 patients have been treated with the sequential regimen. Such a therapy was superior to 7-10 days triple therapies in paediatric, adult and elderly patients, achieving an eradication rate constantly higher than 90% at ITT analysis. Although primary clarithromycin resistance reduced the efficacy of such a therapy, a success rate significantly higher than that observed with the standard 7-10 days triple therapies was found. Conclusion: The 10-day sequential treatment regimen achieves higher eradication rates than standard triple therapies.

Standard triple versus levofloxacin based regimen for eradication ofHelicobacter pylori

“…The STT, using amoxicillin, clarithromycin and omeprazole, is one of the widely used regimens for H. pylori eradication [17] . Different studies have shown different rates of eradication with this regimen, ranging between 76% and 90% [18] . The emergence of resistance of the organism to clarithromycin has urged researchers to look for alternatives to the STT.…”

“…The emergence of resistance of the organism to clarithromycin has urged researchers to look for alternatives to the STT. The sequential therapy and levofloxacin based regimens are two of the newly recommended combinations [18][19][20][21][22] . Levofloxacin based regimens were used as rescue regimens in case of failure with standard regimen [23] .…”

Effectiveness of different treatment regimens in helicobacter pylori eradication: Ten-year experience of a single institution

“…As a second-line treatment, eradication was successful, with ITT 75.7% and PP 80% (19). In the case of clarithromycin resistance, it was suggested that consecutive therapies comprising three antibiotics can increase the eradication rate (43)(44)(45)(46). In the treatment arm beginning with amoxicillin 1000 mg b.i.d.…”

New concepts of resistance in the treatment of Helicobacter pylori infections

“…to complete 10 days. It is typically produces Grade B results and is proven to be superior to traditional triple therapy which produces a Grade F result 57 . It is probable that the results can be improved to Grade A results by continuing the amoxicillin throughout the entire treatment period and/or by extending the duration to 14 days.…”

“…From reference 14 , with permission. Weight mean and 95% confidence intervals for 16 studies of sequential therapy (n = 1805) for 10 days(modified intention-to-treat) 57 and 9 studies of concomitant therapy (n = 715) ranging from 3 to 7 days (intention-to-treat) [59][60][61][62][63][64][65][66][67] .…”