Original Article

Comparison of Two Different Treatment Protocols in Helicobacter pylori Eradication

Authors: Isilay Nadir, MD, Ozlem Yonem, MD, Yasemin Ozin, MD, Zeki Mesut Yalin Kilic, MD, Orhan Sezgin, MD

Abstract

Background: The prevalence of Helicobacter pylori (H pylori) in Turkey is high and eradication rates are low. As a result, alternative treatment strategies are required.


Objectives: To evaluate the status of H pylori eradication in Turkey by comparing the results of this study to other studies reported in the literature.


Methods: Two hundred and eighty-two patients diagnosed with H pylori were included in this study. Patients were randomized into two groups. The first group consisted of 138 patients receiving 30 mg lansoprazole bid, amoxicillin 1 g bid, and clarithromycin 500 mg bid for 14 days. The second group consisted of 144 patients who received lansoprazole 30 mg bid and amoxicillin 1 g bid for seven days, followed by metronidazole 500 mg bid, tetracycline 500 mg qid, and lansoprazole 30 mg bid for an additional seven days.


Results: H pylori eradication rates in the first group were 53.6% according to intention-to-treat analysis, and 52.5% according to per protocol analysis. In the second group, eradication rates were 72.2% per intention-to-treat analysis and 77.6% as per protocol analysis. H pylorieradication rates in the second group were significantly higher than the first group (P = 0.001,P < 0.05), whereas the incidence of adverse events in the second group was significantly lower (P = 0.048, P < 0.05).


Conclusion: This study found a significant difference in eradication rates between the traditional triple therapy and modified sequential therapy groups. As a result, modified sequential therapy shows promise as an alternative treatment.


Key Points


* Helicobacter pylori (H pylori) infection is the major etiological factor in the pathogenesis of peptic ulcer and gastric neoplasia.


* The most promising alternative to standard triple therapy seems to be modified sequential therapy.


* The existence of clarithromycin in the alternative treatment regimen is not virtual, due to the high ratio of clarithromycin resistance. This fact is important, especially for underdeveloped and developing countries in which H pylori is a major public health problem.

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