Ten-Day Sequential Treatment for Helicobacter pylori Eradication in Clinical Practice

BACKGROUND: Cure rates of Helicobacter pylori infection with standard triple therapy are disappointingly low. A very effective, new sequential treatment schedule has recently been described. However, all studies published to date were performed in Italy; it is mandatory to confirm these results in other settings. AIM: To assess the cure rate and the acceptability of a new sequential treatment regimen through a pilot study. METHODS: A hundred and thirty-nine patients (60% men, mean age 49.6 +/- 15.7 yr) were recruited from six centers. H. pylori status was assessed by histology, urease test or urea breath test. Sequential regime consisted of a 10-day treatment including a proton pump inhibitor (PPI) b.d. plus amoxicillin 1 g b.d. for the first 5 days, followed by a PPI b.d. clarithromycin 500 mg b.d. and metronidazole 500 mg b.d for the next 5 days. Eradication was determined 8 wk after the end of treatment by urea breath test or histology. Eradication rates were calculated both per protocol and by intention-to-treat. RESULTS: Eradication was achieved in 117 out of 129 patients who returned for a follow-up test. The intention-to-treat eradication rate was thus 84.2% (95%Cl: 77%-90%) and the per-protocol cure rate 90.7% (95%Cl: 84%-95%). The treatment was well tolerated. Only 14 patients complained of mild side effects. CONCLUSIONS: Sequential treatment seems highly effective for eradicating H. pylori.