Sequential Therapy Versus Standard Triple Therapy in Helicobacter Pylori Eradication in a High Clarithromycin Resistance Setting

Sequential treatment scheme has been developed to overcome resistance problem in H. pylori eradication and favorable results have been obtained. This study compared the results of standard triple therapy with a sequential schema consisting of pantoprazole, amoxicillin, clarithromycin, and metronidazole in a high anti-microbial resistance setting. This retrospective study included subjects that underwent standard or sequential eradication treatment after a diagnosis of biopsy-documented H. pylori infection. Patients either received pantoprazole 40 mg bid, amoxicillin 1000 mg bid and clarithromycin 500 mg bid (PAC) for 10 days, or pantoprazole 40 mg bid and amoxicillin 1000 mg bid (PA) for the first 5 days of the treatment period and were then given pantoprazole 40 mg bid, clarithromycin 500 mg bid, and metronidazole 500 mg bid (PCM) in the remaining 5 days. Eradication was tested using urea breath test. The two treatment groups did not differ with regard to H. pylori eradication rate for both ITT population (63.9% versus 71.4% for standard and sequential therapy respectively, P = 0.278) and per protocol population (65.9% versus 74.1% for standard and sequential therapy respectively, P = 0.248). Although a sequential treatment appears to represent a plausible alternative, our findings suggest that alternative schedules may be required in certain populations to achieve higher success rates.