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Optimized 14-d sequential treatment shows higher cure rates and better tolerance in H. pylori

Helicobacter pylori Helicobacter pylori
Helicobacter pylori Helicobacter pylori

The global challenge of Helicobacter pylori (H. pylori) cure persists amid rising antimicrobial resistance. Optimizing sequential therapy, particularly with new-generation proton-pump inhibitors (PPIs), offers an effective and cost-efficient treatment.

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Key take away

Utilizing an optimized sequential regimen for 14 days with Rabeprazole can achieve comparable eradication rates to non-bismuth quadruple concomitant therapy, with fewer adverse events and greater cost-effectiveness.

Background

The global challenge of Helicobacter pylori (H. pylori) cure persists amid rising antimicrobial resistance. Optimizing sequential therapy, particularly with new-generation proton-pump inhibitors (PPIs), offers an effective and cost-efficient treatment.

To compare the effectiveness, adverse event rates, and cost of an optimized sequential therapy and standard non-bismuth quadruple treatment lasting 10 and 14 days.

Method

In this prospective open-label study, 328 patients diagnosed with H. pylori infection were randomized to 3 groups (1:1:1):

  • First group (QT-10): 10-day quadruple therapy with Omeprazole 20 mg + Amoxicillin 1 g + Clarithromycin 500 mg + Metronidazole 500 mg given twice-daily
  • Second group (QT-14): Same as the first group but for 14 days
  • Third group (OST-14): Optimized sequential treatment with Rabeprazole 20 mg + Amoxicillin 1 g twice daily initially for a week, then Rabeprazole 20 mg twice daily, finally Clarithromycin 500 mg twice daily + Metronidazole 500 mg for the next 7 days

Adverse events were recorded throughout the study. A 13C urea breath test was used to determine the H. pylori infection eradication rate about 4 to 6 weeks after the treatment.

Result

The H. pylori eradication rate was higher in the OST-14 group (93.5%, 85.5% P = 0.04) than QT-10 group (96.2%, 89.5% P = 0.03) in the intention-to-treat and per-protocol analysis. On the other hand, no statistically noteworthy difference in eradication rates between the second and third groups was found. Patients in the OST-14 group had considerably fewer adverse events and was the most cost-effective therapy among the three.

Conclusion

The optimized 14-day sequential therapy is a safe and efficacious alternative, exhibiting eradication rates comparable to 14-day concomitant therapy.

Source:

World Journal of Gastroenterology

Article:

Optimized sequential therapy vs 10- and 14-d concomitant therapy for eradicating Helicobacter pylori: A randomized clinical trial

Authors:

Hassan Seddick et al.

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