New Sequential Versus Triple Treatment Schedules for Helicobacter pylori Eradication in Iran

Selection of the best approach for the treatment of Helicobacter pylori (H. pylori) infection that encompasses higher eradication and lower failure rates leads to a decline in its related complications and disorders. To understand the relative efficacy of new sequential therapy compared with standard triple therapy as two common regimens, we have performed a randomized, controlled trial to compare these two treatment protocols in an Iranian population. This study enrolled 220 patients aged 18-81 years old with dyspepsia or peptic ulcers who were candidates for endoscopy and referred to Taleghani Hospital, Tehran, Iran. Patients were randomized to receive one of two treatment regimens, a 14-day new sequential therapy that consisted of omeprazole (20 mg), amoxicillin (1.0 g), and ciprofloxacin (500 mg) administered twice daily for the first seven days, followed by omeprazole (20 mg), amoxicillin (1.0 g), and furazolidon (200 mg) administered twice daily for the remaining seven days. The second regimen comprised a proton pump inhibitor (PPI)-based triple therapy of omeprazole (20 mg), amoxicillin (1.0 g), and clarithromycin(500 mg) administered twice daily for 14 days. Overall, 10 patients in PPI-based triple therapy group and 16 patients in the 14-day new sequential group stopped treatment and did not undergo 13C-urea breath testing (UBT). Among the remaining patients, the eradication rate with the PPI-based triple therapy was 89.0%, whereas it was 91.5% with the 14-day new sequential therapy which was not significantly different. No significant differences were found in eradication rates between genders in each treatment group. Adverse effects were mainly mild and comparable between the two treatment regimens. It seems that sequential regimen is at least as effective as standard therapy and can be used as an alternative treatment for H pylori eradication.