Randomized Clinical Trial on the Efficacy of Triple Therapy Versus Sequential Therapy in Helicobacter pylori Eradication

Zain Sharif; Muaz Mubashir; Mehdi Naqvi; Hassan Atique; Saira Mahmood; Muneeb Ullah

doi:10.7759/cureus.24897

Randomized Clinical Trial on the Efficacy of Triple Therapy Versus Sequential Therapy in Helicobacter pylori Eradication

Cureus. 2022 May 10;14(5):e24897. doi: 10.7759/cureus.24897. eCollection 2022 May.

Authors

Zain Sharif¹, Muaz Mubashir², Mehdi Naqvi³, Hassan Atique², Saira Mahmood⁴, Muneeb Ullah⁴

Affiliations

¹ Gastroenterology, Nishtar Hospital Multan, Multan, PAK.
² Internal Medicine, Federal Government Polyclinic Hospital, Islamabad, PAK.
³ Internal Medicine/Gastroenterology, Federal Government Polyclinic Hospital, Islamabad, PAK.
⁴ General Surgery, Maroof International Hospital, Islamabad, PAK.

Abstract

Introduction: Helicobacter pylori (H. pylori) colonization is prevalent all over the world, and it is associated with low socioeconomic status, poor hygiene, and overcrowding. Its eradication is important since it is an etiologic agent for gastritis, peptic ulcer, gastric carcinoma, and mucosa-associated lymphoid tissue lymphoma. Different regimens are available for the eradication of H. pylori and include triple therapy and sequential therapy. Our study aims to compare the efficacy of triple therapy versus sequential therapy in the eradication of H. pylori.

Material and methods: This randomized clinical trial was conducted at the Pakistan Institute of Medical Sciences Hospital, Islamabad, from September 2016 to September 2017 after the approval of the institutional review board. A total of 160 patients were enrolled and equally divided into two, group A and group B. A twice-daily dose of amoxicillin 1,000 mg, rabeprazole 20 mg, and clarithromycin 500 mg was given to group A for 10 days, while group B was initially given rabeprazole 20 mg and amoxicillin 1,000 mg two times daily for the first five days (i.e., induction phase), followed by triple therapy that included rabeprazole 20 mg, clarithromycin 500 mg, and metronidazole/tinidazole 500 mg twice daily for the next five days. A negative stool antigen test performed four weeks after the completion of therapy was considered an effective eradication. A proforma was used to collect data that included age, gender, city or province of residence, family income, group (group A or group B), and eradication efficacy. Analysis of the data was performed using the Statistical Package for the Social Sciences version 17 (SPSS Inc., Chicago, USA).

Results: A total of 160 patients were included, with mean age and standard deviation of 40.02±24.4 years. The male/female ratio was 1.8:1. Successful eradication of H. pylori achieved in group A was 67.5% (N=54) in comparison to group B, which was 95% (N=76) (p=0.001).

Conclusion: Sequential therapy was superior to triple therapy in H. pylori eradication.

Keywords: antimicrobial; eradication therapy; h. pylori; helicobacter pylori; randomized trial; sequential therapy; stool antigen; triple therapy.