Ten and Eight-day Sequential Therapy in Comparison to Standard Triple Therapy for Eradicating Helicobacter pylori Infection A Randomized Controlled Study on Efficacy and Tolerability

Background: Sequential therapy (SQT) is effective in the eradication of Helicobacter pylori and could become an alternative to standard triple therapy (STT). Aim: To compare the efficacy and tolerability of SQT, for either 8 or 10 days, with a 7-day STT. Methods: A total of 270 naive H. pylori-positive patients were randomized to receive: SQT for 8 days (SQT-8, n = 90) or 10 days (SQT-10, n = 90) including esomeprazole 20 mg twice daily (bid) associated with amoxicillin 1000 mg bid (early 4 and 5 d, respectively), followed by esomeprazole 20 mg bid associated with clarithromycin 500 mg bid plus tinidazole 500 mg bid (last 4 and 5 d, respectively); STT (n = 90) including esomeprazole 20 mg bid plus amoxicillin 1000 mg bid and clarithromycin 500 mg bid for 7 days. Tolerability was assessed by scoring the severity of symptoms. Results: Eradication rates after SQT-8 and SQT-10 were higher than that of after STT at both intention-to-treat (83% and 86% vs. 66%, P < 0.02) and per-protocol analysis (90% and 88% vs. 75%, P < 0.05), whereas no difference was found between the 2 SQTs. Conclusions: This study shows that SQT, for 8 or 10 days, is well tolerated and highly effective in H. pylori eradication and could represent a valid alternative to STT. Further studies, with more power, on larger populations and from other countries are necessary to validate the present findings.