Helicobacter pylori eradication rates of concomitant and sequential therapies in Korea

The efficacy of the standard triple therapy for Helicobacter pylori eradication has decreased to an unacceptable level. We aimed to compare the efficacy of sequential and concomitant therapies as for the first-line treatments for H. pylori eradication and analyzed the effect of clarithromycin resistance on the eradication rates.

Four hundred and seventy-eight patients with H. pylori infection were randomly assigned to either concomitant therapy (amoxicillin 1000 mg with clarithromycin 500 mg, metronidazole 500 mg, and pantoprazole 40 mg twice daily for 10 days) or sequential therapy (amoxicillin 1000 mg with pantoprazole 40 mg twice daily for 5 days, followed by clarithromycin 500 mg with metronidazole 500 mg and pantoprazole 40 mg twice daily for 5 days). The success of the eradication was evaluated 4-5 weeks after treatment completion. To evaluate the efficacy of the two regimens according to clarithromycin sensitivity, dual-priming oligonucleotide-based multiplex-polymerase chain reaction was also performed in the final third of the enrolled study populations.

The eradication rates with concomitant or sequential therapy were 81.9% and 76.6% (P = .153) in intention-to-treat analysis, and 93.4% and 84.8% (P = .004) in per-protocol analysis, respectively. Among the 156 patients for whom dual-priming oligonucleotide-based multiplex-polymerase chain reaction was performed, 17.9% were clarithromycin resistant, and the efficacy of concomitant therapy was better than sequential therapy in the clarithromycin-resistant strains (100% vs 58.3%, P = .010).

Concomitant therapy was superior to sequential therapy as the first-line treatment for H. pylori eradication, especially in clarithromycin-resistant strains in Korea.