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Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: a prospective randomized study

  • Pharmacoepidemiology and Prescription
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Abstract

Purpose

Eradication rates following standard triple therapy for Helicobacter pylori infection are declining. Recent studies, conducted in a number of countries, have shown that sequential therapy for H. pylori infection yields high cure rates.

Aim

To compare the efficacy and tolerability of a sequential regimen as a first-line treatment of H. pylori infection with a standard triple treatment regime in Morocco.

Methods

A total of 281 naive H. pylori-infected patients, confirmed by histological examination, were assigned randomly to one of two treatment groups: standard triple therapy [omeprazole (20 mg bid) + amoxicillin (1 g bid) + clarithromycin (500 mg bid) for 7 days] or sequential therapy [omeprazole (20 mg bid) + amoxicillin (1 g bid) for 5 days, followed by omeprazole (20 mg bid) + tinidazole (500 mg bid) + clarithromycin (500 mg bid) for an additional 5 days]. H. pylori eradication was checked 4–6 weeks after treatment initiation by using a 13C-urea breath test. Compliance and adverse events were assessed.

Results

The two groups did not differ significantly in gender, age, previous disease history, endoscopic and histological features and smoking. The intention-to-treat and per-protocol eradication rates were 65.9 and 71 % in the standard triple therapy group, and 82.8 and 89.9 % in the sequential therapy group, respectively. The eradication rate was significantly higher in the sequential therapy group than in the standard triple therapy group (p < 0.001), There was no statistically significant difference in compliance (97.5  vs. 96.3 %) and incidence of side-effects (27.5 vs. 27.9 %) between the two groups.

Conclusions

Based on our results, we conclude that for eradication of H. pylori infection, the 10-day sequential therapy is more effective than the standard triple therapy and is equally tolerated. These results confirm those of other studies in other countries.

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Authors and Affiliations

  1. Department of Gastroenterology II, Mohammed V Teaching Military Hospital, Rabat, Morocco

    Hassan Seddik, Tarek El Adioui, Fatim-Zohra El Hamdi & Ahmed Benkirane

  2. Pharmacoepidemiology and Pharmacoeconomics Research Team, Medical and Pharmacy School, Mohammed V–Souissi University, Rabat, Morocco

    Samir Ahid, Mohammed Hassar & Yahia Cherrah

  3. Biostatistics, Clinical and Epidemiological Research Laboratory, Medical and Pharmacy School, Mohammed V–Souissi University, Rabat, Morocco

    Samir Ahid & Redouane Abouqal

  4. Laboratory of Pharmacology and Toxicology, Medical and Pharmacy School–Rabat, Avenue Mohammed Belarabi Elalaoui, BP 6203, Rabat, 10100, Morocco

    Samir Ahid

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  1. Hassan Seddik
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  2. Samir Ahid
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  4. Fatim-Zohra El Hamdi
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Correspondence to Samir Ahid.

Additional information

Hassan Seddik and Samir Ahid contributed equally to this study

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Seddik, H., Ahid, S., El Adioui, T. et al. Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: a prospective randomized study. Eur J Clin Pharmacol 69, 1709–1715 (2013). https://doi.org/10.1007/s00228-013-1524-6

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  • DOI: https://doi.org/10.1007/s00228-013-1524-6

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