Helicobacter pylori eradication rates of concomitant and sequential therapies in Korea

BackgroundThe efficacy of the standard triple therapy for Helicobacter pylori eradication has decreased to an unacceptable level. We aimed to compare the efficacy of sequential and concomitant therapies as for the first-line treatments for H. pylori eradication and analyzed the effect of clarithromycin resistance on the eradication rates. Materials and MethodsFour hundred and seventy-eight patients with H. pylori infection were randomly assigned to either concomitant therapy (amoxicillin 1000mg with clarithromycin 500mg, metronidazole 500mg, and pantoprazole 40mg twice daily for 10days) or sequential therapy (amoxicillin 1000mg with pantoprazole 40mg twice daily for 5days, followed by clarithromycin 500mg with metronidazole 500mg and pantoprazole 40mg twice daily for 5days). The success of the eradication was evaluated 4-5weeks after treatment completion. To evaluate the efficacy of the two regimens according to clarithromycin sensitivity, dual-priming oligonucleotide-based multiplex-polymerase chain reaction was also performed in the final third of the enrolled study populations. ResultsThe eradication rates with concomitant or sequential therapy were 81.9% and 76.6% (P=.153) in intention-to-treat analysis, and 93.4% and 84.8% (P=.004) in per-protocol analysis, respectively. Among the 156 patients for whom dual-priming oligonucleotide-based multiplex-polymerase chain reaction was performed, 17.9% were clarithromycin resistant, and the efficacy of concomitant therapy was better than sequential therapy in the clarithromycin-resistant strains (100% vs 58.3%, P=.010). ConclusionConcomitant therapy was superior to sequential therapy as the first-line treatment for H. pylori eradication, especially in clarithromycin-resistant strains in Korea.