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Ten-day sequential versus triple therapy for Helicobacterpylori eradication: A prospective, open-label, randomized trial

Authors
Chung J.-W.Jung Y.K.Kim Y.J.Kwon K.A.Kim J.H.Lee J.J.Lee S.M.Hahm K.B.Lee S.M.Jeong J.Y.Yun S.-C.
Issue Date
2012
Keywords
Antibiotics resistance; Clarithromycin; Helicobacter pylori; Metronidazole; Peptic ulcer disease
Citation
Journal of Gastroenterology and Hepatology (Australia), v.27, no.11, pp 1675 - 1680
Pages
6
Indexed
SCI
SCIE
SCOPUS
Journal Title
Journal of Gastroenterology and Hepatology (Australia)
Volume
27
Number
11
Start Page
1675
End Page
1680
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/12816
DOI
10.1111/j.1440-1746.2012.07249.x
ISSN
0815-9319
1440-1746
Abstract
Background and Aim: Increased resistance of Helicobacter pylori to antibiotics has increased the need to develop new first-line treatments for H.pylori. We have prospectively evaluated 10-day sequential versus conventional triple therapy in peptic ulcer patients. Methods: One hundred and fifty-nine patients with peptic ulcer diseases were prospectively randomized to receive 10days of lansoprazole, amoxicillin, and clarithromycin (conventional triple therapy) or 5days of lansoprazole and amoxicillin followed by 5days of lansoprazole, clarithromycin, and metronidazole (sequential therapy). Post-treatment H.pylori status was determined by the 13C-urea breath test. Eradication rates, antibiotic resistance rates by agar dilution method, drug compliance, and side-effects were compared. Results: The intention-to-treat eradication rates were 75.9% (95% CI 66.5-85.3%, 60/79) in the sequential therapy group and 58.7% (95% CI 47.9-69.5%, 47/80) in the conventional triple therapy group (P=0.01), while the per-protocol eradication rates were 86.8% (95% CI 78.7-94.8%, 59/68) and 67.6% (95% CI 56.5-78.7%, 46/68) (P=0.01), respectively. Compliance and side-effects were similar in the two groups. Culture of H.pylori showed that 18.2% were resistant to clarithromycin, 41.9% to metronidazole. Dual resistance to both antibiotics was 9.6%. Conclusions: Although 10-day sequential therapy yielded a higher H.pylori eradication rate than 10-day conventional triple therapy, the sequential therapy protocol did not result in a sufficiently satisfactory eradication rate. This might be related to the higher antibiotics resistance rate especially to dual resistance. More effective regimens are needed to overcome antibiotic resistance in Korea. © 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley P1ublishing Asia Pty Ltd.
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Ansan Hospital (Department of Gastroenterology and Hepatology, Ansan Hospital)
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