Comparison of standard, sequential, and concomitant first line eradication therapy for H. pylori

Introduction:

As H. pylori can be a major cause of gastric diseases, eradication of H. pylori infection is important. However, the eradication rates after fist-line standard triple therapy have continuously decreased, mainly because of the widespread development of antibiotic resistance, particularly towards clarithromycin. In fact, many guidelines recommend alternative regimens such as sequential and concomitant therapy. We compared the efficacy, adverse events, and drug compliance of standard triple, sequential, and concomitant therapy for H. pylori eradication.

Methods:

This was a prospective study involving 750 patients diagnosed with H. pylori infection between January 2014 and July 2016 in Yeouido St. Mary's Hospital. Diagnosis was made by rapid urease test or histological evidence of H. pylori via modified Giemsa staining. We compared 3 treatment regimens: the standard triple therapy, the sequential therapy and the concomitant. Six weeks following completion of therapy, successful H. pylori eradication was defined by a negative 13C-urea breath test result.

Results:

A total of 647 patients were analyzed. The eradication rate was significantly higher in the concomitant group (89. 4%, 203/227) than in the standard group (78. 5%, 146/209) and the sequential group (85. 3%, 180/211) (p = 0. 006). Drug compliance and adverse events were not statistically different among the three groups.

Discussion:

Concomitant therapy appears to be more effective for H. pylori eradication compared to standard triple therapy and sequential therapy. There were no statistically different adverse events among the three groups.