Triple therapy versus sequential therapy for the first-line Helicobacter pylori eradication

Area of Science:

• Gastroenterology
• Infectious Diseases
• Microbiology

Background:

• Standard triple therapy for Helicobacter pylori eradication has declining efficacy, with rates between 70-85%.
• Rising antibiotic resistance necessitates evaluating alternative first-line treatment strategies.

Purpose of the Study:

• To compare the efficacy of 7-day triple therapy versus 10-day sequential therapy for first-line H. pylori eradication.
• To assess the tolerability and adverse events associated with both treatment regimens.

Main Methods:

• Retrospective analysis of 1240 H. pylori positive patients treated between January 2013 and December 2015.
• Exclusion of patients with prior H. pylori treatment or gastric surgery.
• Comparison of eradication rates using intention-to-treat and per-protocol analyses.

Main Results:

• Sequential therapy achieved significantly higher H. pylori eradication rates (81.9% intention-to-treat, 90.3% per-protocol) compared to triple therapy (64.3% intention-to-treat, 81.9% per-protocol).
• No significant difference in overall adverse events was observed between the two groups.
• Bismuth-containing quadruple therapy demonstrated comparable efficacy as rescue therapy after sequential treatment.

Conclusions:

• The efficacy of standard triple therapy for H. pylori eradication falls below recommended thresholds.
• 10-day sequential therapy presents a viable, effective, and tolerable option for first-line H. pylori eradication.
• Further research may explore optimal rescue strategies following sequential therapy.