Sequential therapy for Helicobacter pylori eradication: a critical review

Area of Science:

• Gastroenterology
• Infectious Diseases
• Pharmacology

Background:

• Standard triple therapy for Helicobacter pylori infection has limitations, necessitating alternative treatment regimens.
• High rates of antibiotic resistance and treatment failures underscore the need for improved H. pylori eradication strategies.

Purpose of the Study:

• To critically review the evidence supporting the efficacy of the sequential regimen for H. pylori infection treatment.
• To evaluate the effectiveness of sequential therapy in various patient populations and against different bacterial factors.

Main Methods:

• Comprehensive bibliographical searches were conducted using MEDLINE and international congress databases.
• Analysis included pooled-data studies and meta-analyses comparing sequential therapy with standard triple therapy.

Main Results:

• Sequential regimen demonstrated superior efficacy compared to standard triple therapy in multiple analyses.
• Efficacy of sequential therapy is largely unaffected by bacterial factors (CagA status, infection density) and host factors (underlying disease, smoking).
• Clarithromycin resistance was the primary factor reducing efficacy, yet acceptable eradication rates (>75%) were still achievable.

Conclusions:

• Sequential therapy presents a novel and promising treatment strategy for H. pylori infection.
• Further extensive research across diverse patient groups is required before widespread clinical recommendation.
• Nonbismuth quadruple therapy is identified as a safe, effective, and less complex alternative to standard triple therapy.