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Comparison of Standard, Sequential, and Concomitant First Line Eradication Therapy forH. pylori


Park, Eun hyea MD

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American Journal of Gastroenterology: October 2017 - Volume 112 - Issue - p S678
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Introduction: As H. pylori can be a major cause of gastric diseases, eradication of H. pylori infection is important. However, the eradication rates after fist-line standard triple therapy have continuously decreased, mainly because of the widespread development of antibiotic resistance, particularly towards clarithromycin. In fact, many guidelines recommend alternative regimens such as sequential and concomitant therapy. We compared the efficacy, adverse events, and drug compliance of standard triple, sequential, and concomitant therapy for H. pylori eradication.

Methods: This was a prospective study involving 750 patients diagnosed with H. pylori infection between January 2014 and July 2016 in Yeouido St. Mary's Hospital. Diagnosis was made by rapid urease test or histological evidence of H. pylori via modified Giemsa staining. We compared 3 treatment regimens: the standard triple therapy consisted of rabeprazole 20 mg, amoxicillin 1 g, and clarithromycin 500 mg twice a day for 7 days; the sequential therapy consisted of rabeprazole 20 mg, amoxicillin 1 g twice a day for the initial 5 days, followed by rabeprazole 20 mg, clarithromycin 500 mg, and metronidazole 500 mg twice a day for the subsequent 5 days; the concomitant therapy consisted of rabeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg twice a day for 7 days. Six weeks following completion of therapy, successful H. pylori eradication was defined by a negative 13C-urea breath test result. Adverse events and drug compliance were evaluated by physicians via direct questioning. One-hundred and three patients did not complete the study because of loss of follow-up or withdrawal of consent.

Results: A total of 647 patients were analyzed. The eradication rate was significantly higher in the concomitant group (89.4%, 203/227) than in the standard group (78.5%, 146/209) and the sequential group (85.3%,180/211)(p=0.006). Drug compliance and adverse events were not statistically different among the three groups.

Conclusion: Concomitant therapy appears to be more effective for H. pylori eradication compared to standard triple therapy and sequential therapy. There were no statistically different adverse events among the three groups.

Table. Baseline characteristics
Table. Comparison on major outcomes between therapy
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