Helicobacter pylori treatment: is sequential or quadruple therapy the answer?

Clarithromycin resistance is a growing problem in many countries. Eradication rates for Helicobacter pylori have declined to unacceptable levels in recent years, in large measure because of clarithromycin resistance. Two treatment strategies (quadruple therapy and sequential therapy) are emerging as alternatives to triple therapy for the initial treatment of patients infected with H. pylori. Evidence shows that both quadruple therapy and sequential therapy are superior to triple therapy in patients with resistant strains of H. pylori. Studies that compare sequential and quadruple therapy are necessary and are awaited.