Sequential Therapy vs Quadruple Therapy for Helicobacter pylori Eradication in South West of Iran

medical complications, the long duration of treatment and resistance to medications.Furazolidone causes side effects, such as nausea, vomiting and teratogenicity.A 57.5% resistance to metronidazole and 16.7% resistance to clarithromycin have been detected.5 Clarithromycin resistance reduced the eradication rate in the standard triple therapy.In communities with a higher than 15% resistance to clarithromycin, it is not recommended.6 Ten-day sequential therapy, including proton pump inhibitors (PPI) and amoxicillin for ABSTRACT Aim: To compare the efficacy of quadruple and sequential therapy in eradication of Helicobacter pylori (H.pylori) in a randomized study.Method: Three hundred H. pylori positive patients were enrolled into the study.These patients were randomly divided into two groups: group I (n = 150) received quadruple therapy (20 mg omeprazole bid, 240 mg bismuth subcitrate bid, 1,000 mg tetracycline bid and 500 mg metronidazole bid) for 14 days, group II (n = 150) received sequential therapy (20 mg omeprazole bid, 1,000 mg amoxicillin bid for 5 days, followed by 20 mg omeprazole bid, 500 mg metronidazole bid, 500 mg clarithromycin for the other 5 days).H. pylori status was assessed by histology and rapid urease test at baseline.Follow-up breath test by 14C urea breath test (UBT) was performed 4 weeks after completion of treatment.Eradication was defined as negative results on UBT.Results: Successful eradication was achieved in 245 patients.In each group, five patients did not tolerate the regimen and were excluded from analysis.About 29 (20%) patients who received sequential therapy and 21 (14.5%) of the quadruple group tolerated mild side effects (p = 0.21).Per-protocol analysis demonstrated eradication rates of 86.9% for sequential therapy and 82.7% for quadruple therapy (p = 0.26).Results according to the intention to treat analysis were 84 and 79.5% in the sequential and quadruple group respectively.Eradication rate differences were not significant. Conclusion:The success rate of sequential therapy is comparable with quadruple therapy.Sequential therapy due to the short duration and lesser drug usage is a good alternative for eradication of H. pylori in the country.