Ten-day sequential versus triple therapy for Helicobacterpylori eradication: A prospective, open-label, randomized trial

Jun Won Chung, Young Kul Jung, Yoon Jae Kim, Kwang Ahn Kwon, Jung Ho Kim, Jong Joon Lee, Sung Min Lee, Ki Baik Hahm, Sun Mi Lee, Jin Yong Jeong, Sung Cheol Yun

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background and Aim: Increased resistance of Helicobacter pylori to antibiotics has increased the need to develop new first-line treatments for H.pylori. We have prospectively evaluated 10-day sequential versus conventional triple therapy in peptic ulcer patients. Methods: One hundred and fifty-nine patients with peptic ulcer diseases were prospectively randomized to receive 10days of lansoprazole, amoxicillin, and clarithromycin (conventional triple therapy) or 5days of lansoprazole and amoxicillin followed by 5days of lansoprazole, clarithromycin, and metronidazole (sequential therapy). Post-treatment H.pylori status was determined by the 13C-urea breath test. Eradication rates, antibiotic resistance rates by agar dilution method, drug compliance, and side-effects were compared. Results: The intention-to-treat eradication rates were 75.9% (95% CI 66.5-85.3%, 60/79) in the sequential therapy group and 58.7% (95% CI 47.9-69.5%, 47/80) in the conventional triple therapy group (P=0.01), while the per-protocol eradication rates were 86.8% (95% CI 78.7-94.8%, 59/68) and 67.6% (95% CI 56.5-78.7%, 46/68) (P=0.01), respectively. Compliance and side-effects were similar in the two groups. Culture of H.pylori showed that 18.2% were resistant to clarithromycin, 41.9% to metronidazole. Dual resistance to both antibiotics was 9.6%. Conclusions: Although 10-day sequential therapy yielded a higher H.pylori eradication rate than 10-day conventional triple therapy, the sequential therapy protocol did not result in a sufficiently satisfactory eradication rate. This might be related to the higher antibiotics resistance rate especially to dual resistance. More effective regimens are needed to overcome antibiotic resistance in Korea.

Original languageEnglish
Pages (from-to)1675-1680
Number of pages6
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume27
Issue number11
DOIs
Publication statusPublished - 2012 Nov 1
Externally publishedYes

Fingerprint

Pylorus
Lansoprazole
Clarithromycin
Microbial Drug Resistance
Amoxicillin
Metronidazole
Therapeutics
Group Psychotherapy
Peptic Ulcer
Compliance
Anti-Bacterial Agents
Breath Tests
Korea
Drug-Related Side Effects and Adverse Reactions
Helicobacter pylori
Agar
Urea

Keywords

  • Antibiotics resistance
  • Clarithromycin
  • Helicobacter pylori
  • Metronidazole
  • Peptic ulcer disease

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Ten-day sequential versus triple therapy for Helicobacterpylori eradication : A prospective, open-label, randomized trial. / Chung, Jun Won; Jung, Young Kul; Kim, Yoon Jae; Kwon, Kwang Ahn; Kim, Jung Ho; Lee, Jong Joon; Lee, Sung Min; Hahm, Ki Baik; Lee, Sun Mi; Jeong, Jin Yong; Yun, Sung Cheol.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 27, No. 11, 01.11.2012, p. 1675-1680.

Research output: Contribution to journalArticle

Chung, Jun Won ; Jung, Young Kul ; Kim, Yoon Jae ; Kwon, Kwang Ahn ; Kim, Jung Ho ; Lee, Jong Joon ; Lee, Sung Min ; Hahm, Ki Baik ; Lee, Sun Mi ; Jeong, Jin Yong ; Yun, Sung Cheol. / Ten-day sequential versus triple therapy for Helicobacterpylori eradication : A prospective, open-label, randomized trial. In: Journal of Gastroenterology and Hepatology (Australia). 2012 ; Vol. 27, No. 11. pp. 1675-1680.
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abstract = "Background and Aim: Increased resistance of Helicobacter pylori to antibiotics has increased the need to develop new first-line treatments for H.pylori. We have prospectively evaluated 10-day sequential versus conventional triple therapy in peptic ulcer patients. Methods: One hundred and fifty-nine patients with peptic ulcer diseases were prospectively randomized to receive 10days of lansoprazole, amoxicillin, and clarithromycin (conventional triple therapy) or 5days of lansoprazole and amoxicillin followed by 5days of lansoprazole, clarithromycin, and metronidazole (sequential therapy). Post-treatment H.pylori status was determined by the 13C-urea breath test. Eradication rates, antibiotic resistance rates by agar dilution method, drug compliance, and side-effects were compared. Results: The intention-to-treat eradication rates were 75.9{\%} (95{\%} CI 66.5-85.3{\%}, 60/79) in the sequential therapy group and 58.7{\%} (95{\%} CI 47.9-69.5{\%}, 47/80) in the conventional triple therapy group (P=0.01), while the per-protocol eradication rates were 86.8{\%} (95{\%} CI 78.7-94.8{\%}, 59/68) and 67.6{\%} (95{\%} CI 56.5-78.7{\%}, 46/68) (P=0.01), respectively. Compliance and side-effects were similar in the two groups. Culture of H.pylori showed that 18.2{\%} were resistant to clarithromycin, 41.9{\%} to metronidazole. Dual resistance to both antibiotics was 9.6{\%}. Conclusions: Although 10-day sequential therapy yielded a higher H.pylori eradication rate than 10-day conventional triple therapy, the sequential therapy protocol did not result in a sufficiently satisfactory eradication rate. This might be related to the higher antibiotics resistance rate especially to dual resistance. More effective regimens are needed to overcome antibiotic resistance in Korea.",
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AU - Jung, Young Kul

AU - Kim, Yoon Jae

AU - Kwon, Kwang Ahn

AU - Kim, Jung Ho

AU - Lee, Jong Joon

AU - Lee, Sung Min

AU - Hahm, Ki Baik

AU - Lee, Sun Mi

AU - Jeong, Jin Yong

AU - Yun, Sung Cheol

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N2 - Background and Aim: Increased resistance of Helicobacter pylori to antibiotics has increased the need to develop new first-line treatments for H.pylori. We have prospectively evaluated 10-day sequential versus conventional triple therapy in peptic ulcer patients. Methods: One hundred and fifty-nine patients with peptic ulcer diseases were prospectively randomized to receive 10days of lansoprazole, amoxicillin, and clarithromycin (conventional triple therapy) or 5days of lansoprazole and amoxicillin followed by 5days of lansoprazole, clarithromycin, and metronidazole (sequential therapy). Post-treatment H.pylori status was determined by the 13C-urea breath test. Eradication rates, antibiotic resistance rates by agar dilution method, drug compliance, and side-effects were compared. Results: The intention-to-treat eradication rates were 75.9% (95% CI 66.5-85.3%, 60/79) in the sequential therapy group and 58.7% (95% CI 47.9-69.5%, 47/80) in the conventional triple therapy group (P=0.01), while the per-protocol eradication rates were 86.8% (95% CI 78.7-94.8%, 59/68) and 67.6% (95% CI 56.5-78.7%, 46/68) (P=0.01), respectively. Compliance and side-effects were similar in the two groups. Culture of H.pylori showed that 18.2% were resistant to clarithromycin, 41.9% to metronidazole. Dual resistance to both antibiotics was 9.6%. Conclusions: Although 10-day sequential therapy yielded a higher H.pylori eradication rate than 10-day conventional triple therapy, the sequential therapy protocol did not result in a sufficiently satisfactory eradication rate. This might be related to the higher antibiotics resistance rate especially to dual resistance. More effective regimens are needed to overcome antibiotic resistance in Korea.

AB - Background and Aim: Increased resistance of Helicobacter pylori to antibiotics has increased the need to develop new first-line treatments for H.pylori. We have prospectively evaluated 10-day sequential versus conventional triple therapy in peptic ulcer patients. Methods: One hundred and fifty-nine patients with peptic ulcer diseases were prospectively randomized to receive 10days of lansoprazole, amoxicillin, and clarithromycin (conventional triple therapy) or 5days of lansoprazole and amoxicillin followed by 5days of lansoprazole, clarithromycin, and metronidazole (sequential therapy). Post-treatment H.pylori status was determined by the 13C-urea breath test. Eradication rates, antibiotic resistance rates by agar dilution method, drug compliance, and side-effects were compared. Results: The intention-to-treat eradication rates were 75.9% (95% CI 66.5-85.3%, 60/79) in the sequential therapy group and 58.7% (95% CI 47.9-69.5%, 47/80) in the conventional triple therapy group (P=0.01), while the per-protocol eradication rates were 86.8% (95% CI 78.7-94.8%, 59/68) and 67.6% (95% CI 56.5-78.7%, 46/68) (P=0.01), respectively. Compliance and side-effects were similar in the two groups. Culture of H.pylori showed that 18.2% were resistant to clarithromycin, 41.9% to metronidazole. Dual resistance to both antibiotics was 9.6%. Conclusions: Although 10-day sequential therapy yielded a higher H.pylori eradication rate than 10-day conventional triple therapy, the sequential therapy protocol did not result in a sufficiently satisfactory eradication rate. This might be related to the higher antibiotics resistance rate especially to dual resistance. More effective regimens are needed to overcome antibiotic resistance in Korea.

KW - Antibiotics resistance

KW - Clarithromycin

KW - Helicobacter pylori

KW - Metronidazole

KW - Peptic ulcer disease

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