The effects of sequential treatment as a first-line therapy for Helicobacter pylori eradication

Aim: There is no effective eradication regimen for Helicobacter pylori (HP) in Turkey. Recent studies have shown that sequential therapy may be superior to the standard triple therapy in terms of the eradication of HP. In this study, we aim to assess the efficacy of a 14-day sequential treatment regimen as a first-line therapy for HP eradication. Materials and methods: This is a prospective, open-label, single-centre study. The study involved 86 consecutive patients with nonulcer dyspepsia. All patients were randomly assigned into 2 study groups at a 2:1 ratio using random sampling numbers. The first group of patients were administered a sequential treatment: pantoprazole 2 x 40 mg and amoxicillin 2 x 1000 mg for the first 7 days and pantoprazole 2 x 40 mg, metronidazole 2 x 500 mg, and tetracycline 4 x 500 mg for the remaining 7 days. The second group of patients were administered pantoprazole 2 x 40 mg, amoxicillin 2 x 1000 mg, and clarithromycin 2 x 500 mg (PAC) for 14 days. Eradication was defined as the absence HP as assessed with the (14-C) urea breath test 4 weeks after the end of the antimicrobial therapy. Results: The eradication rate in the sequential group was 56.1% for the ITT analysis and 57.1% for the PP analysis, the eradication rate of the PAC group was 58.6 % for both PP and ITT analysis. There was a statistically significant difference between the eradication rates of the groups for both PP and ITT analysis. There was no statistically significant difference in the adverse effects encountered in both groups (10.5% versus 13.8% P > 0.05). Conclusion: These results suggest that a 14-day sequential eradication regimen is not effective as a first-line therapy for HP eradication.