High eradication rates of Helicobacter pylori with a new sequential treatment

Abstract

Background : Eradication rates of Helicobacter pylori with standard triple therapy are disappointing, and studies from several countries confirm this poor performance. Aim : To assess the eradication rate of a new sequential treatment regimen compared with conventional triple therapy for the eradication of H. pylori infection. Methods : One thousand and forty‐nine dyspeptic patients were studied prospectively. H. pylori‐infected patients were randomized to receive 10‐day sequential therapy [rabeprazole (40 mg daily) plus amoxicillin (1 g twice daily) for the first 5 days, followed by rabeprazole (20 mg), clarithromycin (500 mg) and tinidazole (500 mg) twice daily for the remaining 5 days] or standard 7‐day treatment [rabeprazole (20 mg), clarithromycin (500 mg) and amoxicillin (1 g) twice daily]. H. pylori status was assessed by histology, rapid urease test and ¹³C‐urea breath test at baseline and 6 weeks or more after completion of treatment. Results : Higher eradication rates were found with the sequential regimen compared to the standard regimen (intention‐to‐treat: 92% vs. 74%, P < 0.0001; per protocol: 95% vs. 77%, P < 0.0001). Higher eradication rates were also seen in patients with peptic ulcer disease and non‐ulcer dyspepsia. In both treatments, compliance was similar (> 90%), as was the rate of side‐effects, which were mild. Conclusions : This 10‐day sequential treatment regimen achieves high eradication rates in peptic ulcer disease and non‐ulcer dyspepsia.