Helicobacter pylori eradication with either seven-day or 10-day triple therapies, and with a 10-day sequential regimen

BACKGROUND: Helicobacter pylori eradication rates achieved by standard seven,day triple therapies are decreasing in several countries, while a novel 10-day Sequential regimen has achieved a very high success rate. A longer 10-day triple therapy, similar to the sequential regimen, was tested to see whether it could achieve a better infection cure rate. METHODS: patients with nonulcer dyspepsia and H pylori infection were randomly assigned to one of the following three therapies: esomeprazole 20 mg, clarithronrycin 500 mg and amoxycillin I g for seven days or 10 days, or a 10-day sequential regimen including esomeprazole 20 mg Plus amoxycillin 1 g for five days and esoraeprazole 20 mg, clarithromycin 500 mg and tinidazote 500 mg for the remaining five clays. All drugs were given twice daily. H pylori eradication was checked four to six weeks after treatment by using a C-13-urea breath test. RESULTS: Overall, 213 patients were enrolled. H pylori eradication was achieved in 75.7% and 77.9%, in 81.7% and 84.1%, and in 94.4% and 97.1% of patients following seven-day or 10-day triple therapy and the 10-day sequential regimen, at intention-to-treat and per protocol analyses, respectively. The eradication rate following the sequential regimen was higher than either seven-clay (P=0.002) or 10-day triple therapy (P=0.02), while no significant difference emerged between the latter two regimens (P=0.6). CONCLUSIONS: The 10-day sequential regimen was significantly more effective than both triple regimens, while 10-day triple therapy failed to significantly increase the H pylori eradication rate achieved by the standard seven-day regimen.