Sequential Therapy Best for Eradicating H. Pylori

NEW YORK APR 16, 2007 (Reuters Health) - Administering several drugs in sequence is more effective than standard triple-drug therapy for eradicating Helicobacter pylori, according to a report in the Annals of Internal Medicine for April 17.

Worldwide eradication rates for H. pylori have declined as the microbe has become more resistance to various antimicrobials, lead author Dr. Dino Vaira, from the S. Orsola Hospital in Bologna, Italy, and colleagues note.

Previous reports have suggested that sequential therapy might improve eradication rates. However, until now, no double-blind, controlled trials have compared this approach against standard therapy with pantoprazole, clarithromycin, and amoxicillin (40 mg, 500 mg, and 1 g, respectively, twice daily).

The study involved 300 patients with dyspepsia or peptic ulcers who were randomized to receive 10 days of standard therapy or 5 days of pantoprazole (40 mg), amoxicillin (1 g), and placebo twice daily followed by 5 days of pantoprazole (40 mg), clarithromycin (500 mg), and tinidazole (500 mg) twice daily.

Depending on the type of analysis, the eradication rates with sequential therapy ranged from 89% to 93%, whereas with standard therapy the rates never exceeded 79%. Sequential therapy was particularly better at eradicating clarithromycin-resistant strains: 89% vs. 29% (p = 0.0034).

Seventeen percent of subjects in each group experienced side effects with no significant difference between the groups in severity. Epigastric pain and diarrhea were the most common side effects. One patient in the standard therapy group discontinued treatment due to side effects.

"Our data suggest that sequential therapy may have a role as a first-line treatment for H. pylori infection," the researchers conclude.

SOURCE:

• Ann Intern Med 2007;146:556-563