Sequential therapy versus standard triple therapy in Helicobacter pylori eradication

Background: The belief that no organism can survive in the acidic environment of the stomach was shuttered by Barry Marshall and Robbin Warren in 1982 when they identified the organism Helicobacter pylori. H. pylori is the main cause of gastritis, peptic ulcer disease, gastric adenocarcinoma and mucosa associated lymphoid tissue lymphoma. The aim of treatment of H. Pylori infection in any clinical situation is eradication of bacterium from the foregut with armamentarium of antibiotic to choice. Aim: to study whether sequential therapy is more effective than standard triple therapy in terms of eradication of Helicobacter pylori. Material and methods: Our hospital based, prospective, randomized study entitled “Sequential therapy versus standard triple therapy in Helicobacter pylori eradication” was conducted and concluded in post graduate department of Medicine, tertiary care institute in 2012. Three hundred patients with documented H. pylori infection studied, were randomized into 3 groups to receive standard or sequential (clarithromycin or levofloxacin based) anti H. pylori therapy. Results: Three hundred patients studied were randomized into 3 groups, one group received standard triple therapy for 10 days (Group A), second group clarithromycin based sequential therapy for 10 days (Group B)and third levofloxacin based sequential therapy for 10 days (Group C). Group A achieved eradication rate of 68% only. While sequential therapy group B and C showed a success of 81 and 86% respectively. In our study, Group B sequential therapy achieved 13% higher eradication as compared to standard triple therapy. Conclusion: In conclusion, our large, prospective, hospital based study shows the superiority of sequential treatment for eradicating H. pylori infection compared with conventional triple therapy. The sequential regimen is less expensive and is more effective than conventional therapy for patients with clarithromycin-resistant organisms. Our data suggest that sequential therapy may have a role as a first line treatment for H. pylori infection.