Efficacy of Sequential Therapy as the First-Line Treatment in the Eradication of Helicobacter pylori

Yonas Tamene; Shefali P Mody; Kaiser O Sadiq; Yogamba M Shivakumar; Eshwar Burra; Kamran Shahid; Tuheen Sankar Nath

doi:10.7759/cureus.45593

Efficacy of Sequential Therapy as the First-Line Treatment in the Eradication of Helicobacter pylori

Cureus. 2023 Sep 20;15(9):e45593. doi: 10.7759/cureus.45593. eCollection 2023 Sep.

Authors

Yonas Tamene¹, Shefali P Mody², Kaiser O Sadiq³, Yogamba M Shivakumar², Eshwar Burra⁴, Kamran Shahid⁵, Tuheen Sankar Nath⁶

Affiliations

¹ Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
² Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
³ Surgery, Plexus Neuro and Stem Cell Research Centre, Bangalore, IND.
⁴ Internal Medicine, Government Medical College, Nizamabad, IND.
⁵ Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
⁶ Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.

Abstract

The Helicobacter pylori infection is a significant issue in global health as it is associated with a range of gastrointestinal disorders and an elevated likelihood of developing stomach cancer. The declining efficacy of standard triple therapy (TT) as the recommended treatment can be attributed to the emergence of drug-resistant strains. Sequential therapy (ST) has been recognized as an alternative approach, wherein a combination of proton-pump inhibitor (PPI) and amoxicillin is administered for the initial five days, followed by a combination of PPI, clarithromycin, and metronidazole for the subsequent five days. In this comprehensive systematic review and meta-analysis, we have thoroughly assessed the effectiveness and tolerability of ST as a primary treatment option in comparison to TT for the eradication of H. pylori. The analysis comprised a total of 15 randomized controlled trials, encompassing a sample size of 5,219 patients. The collective findings indicate that ST exhibits promise as it achieves higher rates of eradication. Additionally, it is worth noting that this approach has the potential to yield cost savings and enhance treatment compliance when compared to TT. To summarize, this systematic review and meta-analysis provide evidence that ST is a viable option for the initial treatment of H. pylori eradication. It shows potential benefits compared to the standard TT, especially when there is resistance to clarithromycin. In order to establish ST as the preferred first-line treatment, it is imperative that additional research be conducted to address the aforementioned limitations and thoroughly investigate its long-term efficacy and safety profiles. Nevertheless, it is required that additional research be conducted in order to adequately tackle the constraints of the current studies and solidify its position as a favored treatment alternative. It is also essential to consider ST as a viable approach to improve the rates of H. pylori eradication. This method should be thoroughly examined in clinical practice to gain a deeper understanding of its effectiveness.

Keywords: h. pylori; h. pylori antibotic; h. pylori eradication; h. pylori infection; helicobacter pylori.

Publication types

Review