Efficacy and safety of sequential therapy versus standard triple therapy in Helicobacter pylori eradication in Kashmir India: a randomized comparative trial

Background Increasing resistance against Helicobacter pylori has resulted in reduced eradication rates. Objective This study aims to determine whether eradication rates for H . pylori infection with sequential therapy is better than standard triple therapy. Patients Patients with endoscopy documented peptic ulcer and H . pylori infection confirmed by histology and rapid urease test. Intervention Patients were randomized into two groups; 134 received standard triple therapy (pantoprazole 40 mg, clarithromycin 500 mg and amoxicillin 1 g each administered twice daily) for 10 days and 138 received sequential regimen (pantoprazole 40 mg plus amoxicillin 1 g twice daily for 5 days followed by 40 mg pantoprazole, 500 mg clarithromycin, and 500 mg tinidazole each administered twice daily for 5 days). Eradication was confirmed by histology and rapid urease test. Compliance and adverse effects were determined by the recovery of empty medicine strips and questioning. Results The eradication rates with sequential therapy were significantly greater than with standard therapy on both intention-to-treat analysis (76.0 % vs. 61.9 %, p = 0.005; difference, 14.1 % [95 % CI, 6.5–19 %] and per protocol analysis (84.6 % vs. 67.4 %, p = 0.002; difference, 17.2 % [95 % CI, 8.5–23.5 %]). The incidence of side effects did not differ between the two therapy groups. One patient in standard therapy discontinued treatment due to side effects. Limitation Cultures were not performed. Loss to follow up was 5.2 % in standard therapy and 6.5 % in sequential therapy. Conclusion Sequential therapy was significantly more effective than standard therapy for eradicating H . pylori infection in peptic ulcer disease in Asian patients. Side effects were similar.