HealthDay News — Both concomitant therapy and sequential therapy achieve high eradication rates as the first-line therapy for Helicobacter pylori in areas with high rates of clarithromycin resistance, according to a study published online in the Journal of Gastroenterology and Hepatology.
Sung Min Park, from Incheon St. Mary’s Hospital in South Korea, and colleagues compared the efficacy and tolerability of 10- or 14-day sequential therapy (ST-10 or ST-14) with that of 10- or 14-day concomitant therapy (CT-10 or CT-14) among 341 randomly assigned H pylori patients. The ST-10 and ST-14 groups received pantoprazole 40 mg and amoxicillin 1 g two times a day for the first five and seven days and pantoprazole 40 mg, clarithromycin 500 mg, and metronidazole 500 mg twice a day for the last five and seven days, respectively. The CT-10 and CT-14 groups received pantoprazole 40 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg twice a day for 10 and 14 days, respectively.
The researchers found that the modified intention-to-treat eradication rates of ST-10, ST-14, CT-10 and CT-14 were 91.7, 91.2, 94.2, and 98.5%, respectively. The corresponding per-protocol eradication rates were 91.4, 91.0, 95.6, and 98.5%. The four groups showed no difference in compliance and adverse events. Eradication rates increased sequentially with statistical significance in the following order: ST-10, ST-14, CT-10 and CT-14 (P = .044).
“All four regimens achieved eradication rates >90% in per-protocol analyses in a country with high clarithromycin resistance,” the authors write.
1. Park SM, Kim JS, Kim BW, et al. A randomised clinical trial comparing 10- or 14-day sequential therapy and 10- or 14-day concomitant therapy for the first line empirical treatment of Helicobacter pylori infection. J Gastro Hepatol. 2016; doi: 10.1111/jgh.13510.