Role of sequential therapy in Helicobacter pylori eradication therapy.

Author(s): Pajares-Garcia JM, Villarroya RP, Gisbert JP

Affiliation(s): Universidad Autonoma, Gastroenterology Department, Hospital Universitario de la Princesa, Madrid, Spain. jmpajaresg@telefonica.net

Publication date & source: 2007-10, Future Microbiol., 2:481-4.

Publication type:

The standard proton pump inhibitor-based triple-drug therapy to cure Helicobacter pylori infection fails in approximately 20% of patients. Antimicrobial resistance is significantly decreasing the eradication rates worldwide. This article evaluates whether sequential treatment is more effective than standard triple-drug therapy in a randomized, double-blind, placebo-controlled trial. The sequential regimen includes pantoprazole and amoxicillin (standard doses), each administered twice daily for the first 5 days, followed by the triple therapy of pantoprazole, clarithromycin and tinidazole (standard doses), each administered twice daily for the remaining 5 days. The results confirm that sequential therapy is more effective than standard therapy for eradicating H. pylori infection, mainly in patients with clarithromycin-resistant strains. Tolerance and compliance are similar with both treatments. These encouraging results should ideally be confirmed in other countries in larger cohorts. However, in the event of sequential therapy failure, the effectiveness of the standard in dual clarithromycin and metronidazole resistance needs to be clarified.