Sequential Therapy vs Quadruple Therapy for
Helicobacter pylori Eradication in South West of Iran
Abdol Rahim Masjedizadeh, Eskandar Hajiani, Seyed Jalal Hashemi, Pezhman Alavinejad, Hasan Dalvand
Citation Information :
Rahim Masjedizadeh A, Hajiani E, Jalal Hashemi S, Alavinejad P, Dalvand H. Sequential Therapy vs Quadruple Therapy for Helicobacter pylori Eradication in South West of Iran. Euroasian J Hepatogastroenterol 2014; 4 (2):63-66.
Aim: To compare the efficacy of quadruple and sequential therapy in eradication of Helicobacter
pylori (H. pylori) in a randomized study.
Method: Three hundred H. pylori positive patients were enrolled into the study. These patients were
randomly divided into two groups: group I (n = 150) received quadruple therapy (20 mg omeprazole
bid, 240 mg bismuth subcitrate bid, 1,000 mg tetracycline bid and 500 mg metronidazole bid) for
14 days, group II (n = 150) received sequential therapy (20 mg omeprazole bid, 1,000 mg amoxicillin
bid for 5 days, followed by 20 mg omeprazole bid, 500 mg metronidazole bid, 500 mg clarithromycin
for the other 5 days). H. pylori status was assessed by histology and rapid urease test at baseline.
Follow-up breath test by 14C urea breath test (UBT) was performed 4 weeks after completion of
treatment. Eradication was defined as negative results on UBT.
Results: Successful eradication was achieved in 245 patients. In each group, five patients did
not tolerate the regimen and were excluded from analysis. About 29 (20%) patients who received
sequential therapy and 21 (14.5%) of the quadruple group tolerated mild side effects (p = 0.21).
Per-protocol analysis demonstrated eradication rates of 86.9% for sequential therapy and 82.7%
for quadruple therapy (p = 0.26). Results according to the intention to treat analysis were 84 and 79.5%
in the sequential and quadruple group respectively. Eradication rate differences were not significant.
Conclusion: The success rate of sequential therapy is comparable with quadruple therapy. Sequential
therapy due to the short duration and lesser drug usage is a good alternative for eradication of
H. pylori in the country.
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