Published online Feb 14, 2024. doi: 10.3748/wjg.v30.i6.556
Peer-review started: October 6, 2023
First decision: November 12, 2023
Revised: November 26, 2023
Accepted: December 29, 2023
Article in press: December 29, 2023
Published online: February 14, 2024
Processing time: 122 Days and 1.7 Hours
A cure for Helicobacter pylori (H. pylori) remains a problem of global concern. The prevalence of antimicrobial resistance is widely rising and becoming a challenging issue worldwide. Optimizing sequential therapy seems to be one of the most attractive strategies in terms of efficacy, tolerability and cost. The most common sequential therapy consists of a dual therapy [proton-pump inhibitors (PPIs) and amoxicillin] for the first period (5 to 7 d), followed by a triple therapy for the second period (PPI, clarithromycin and metronidazole). PPIs play a key role in maintaining a gastric pH at a level that allows an optimal efficacy of antibiotics, hence the idea of using new generation molecules.
To compare an optimized sequential therapy with the standard non-bismuth quadruple therapies of 10 and 14 d, in terms of efficacy, incidence of adverse effects (AEs) and cost.
This open-label prospective study randomized 328 patients with confirmed H. pylori infection into three groups (1:1:1): The first group received quadruple therapy consisting of twice-daily (bid) omeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg and metronidazole 500 mg for 10 d (QT-10), the second group received a 14 d quadruple therapy following the same regimen (QT-14), and the third group received an optimized sequential therapy consisting of bid rabe
In the intention-to-treat and per-protocol analysis, the eradication rate was higher in the OST-14 group compared to the QT-10 group: (93.5%, 85.5% P = 0.04) and (96.2%, 89.5% P = 0.03) respectively. However, there was no statistically significant difference in eradication rates between the OST-14 and QT-14 groups: (93.5%, 91.8% P = 0.34) and (96.2%, 94.4% P = 0.35), respectively. The overall incidence of AEs was significantly lower in the OST-14 group (P = 0.01). Furthermore, OST-14 was the most cost-effective among the three groups.
The optimized 14-d sequential therapy is a safe and effective alternative. Its eradication rate is comparable to that of the 14-d concomitant therapy while causing fewer AEs and allowing a gain in terms of cost.
Core Tip:Helicobacter pylori infection remains a common infection worldwide. The decline in the efficacy of traditional triple therapies since 2010 has required new combinations of antibiotics. The last guidelines of Maastricht VI recommend bismuth quadruple therapies or concomitant quadruple therapies to reach an eradication rate of at least 90%. These values remain higher than those obtained with standard sequential therapy but are associated with a higher cost and more adverse effects (AEs). The results of the present study demonstrate that optimizing sequential therapy by using second-generation proton-pump inhibitors improved eradication rates and reduced AE incidence. This combination can thus be suggested for use in clinical practice.