Eradication Efficacy of Sequential Therapy versus Standard Quadruple Therapy as Rescue Therapies for Failure of Helicobacter pylori Eradication

Background:Efficacy of standard triple therapy for eradication of Helicobacter pylori(H.pylori) is decreasing recently,and it is important to select effective rescue therapy for the patients with failure of H.pylori eradication.Aims: To compare the eradication efficacy of sequential therapy and standard quadruple therapy for patients with failed H.pylori eradication.Methods:Ninety-eight patients who had failed H.pylori eradication were randomly assigned into sequential therapy group(omeprazole 20 mg + amoxicillin 1000 mg bid for 5 days,followed by omeprazole 20 mg + levofloxacin 200 mg + clarithromycin 500 mg bid for 5 days) and standard quadruple therapy group(omeprazole 20 mg + bismuth subcitrate 220 mg + amoxicillin 1000 mg + clarithromycin 500 mg bid for 7 days).Four weeks after the end of treatment,~(14)C-urea breath test was re-examined to assess H.pylori eradication rate.Results:Ninety-five patients completed the study.H. pylori eradication rates by ITT and PP analysis in sequential therapy group were significantly higher than those in standard quadruple therapy group(ITT:89.8%vs.71.4%,PP:91.7%vs.74.5%,P0.05).The symptom remission of sequential therapy group was significantly higher than that of standard quadruple therapy group(95.8%vs.80.9%,P0.05 ).No significant difference in adverse effect rate was found between the two groups(P0.05).Conclusions:Both sequential therapy and standard quadruple therapy can be used as a rescue therapy for eradication of H.pylori in patients with failed H.pylori eradication.The efficacy of 10-day sequential therapy is superior to 7-day standard quadruple therapy.