Neither 10- nor 14-day sequential treatment is better than standard triple therapy for helicobacter pylori eradication

Emanuel Warrington, Orlando López-Román, Rafael Tirado-Montijo, Rafael Urbina, Marcia Cruz-Correa, Doris H. Toro

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objective: Helicobacter pylori is a bacterial pathogen associated with chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue lymphoma. Current treatment guidelines support a 7to 14-day, triple-drug protocol consisting of a proton-pump inhibitor (PPI), clarithromycin, and either amoxicillin or an imidazole. The initial eradication rates for this regimen were 80 to 90%. Nevertheless its effectiveness has declined as the antibiotic resistance to clarithromycin and metronidazole has emerged. In Puerto Rico the reported resistance of H. pylori to clarithromycin is 16% and to metronidazole, 3.7%. Sequential therapy for H. pylori eradication, 5 days of treatment with a PPI and amoxicillin followed by 5 days of treatment with the PPI and 2 other antibiotics (clarithromycin and an imidazole), was introduced as an effective alternate regimen. This is a prospective clinical trial intended to compare the efficacy of first-line, standard 10-day tripledrug therapy with those of both 10and 14-day sequential therapy in eradicating H. pylori at the San Juan Veterans Affairs Hospital in a population that is naïve to previous treatment. Methods: This was a prospective, open-label, randomized clinical trial. Results: Based on the intention-to-treat analysis, the eradication rate was 83.7% (72 of 86 patients) in the standard triple-therapy group, 80.0% (68/85) in the 10day sequential-therapy group, and 79.1% (68/86) in the 14-day sequential-therapy group. There were no significant statistical differences between the eradication rates among therapies. Conclusion: Sequential-therapy treatment regimens are not better than standard triple therapy for the eradication of H. pylori infection, regardless of the treatment duration.

Original languageEnglish (US)
Pages (from-to)203-208
Number of pages6
JournalPuerto Rico Health Sciences Journal
Issue number4
StatePublished - Dec 1 2016
Externally publishedYes


  • Amoxicillin
  • Breath test
  • Helicobacter pylori
  • Proton pump inhibitors
  • Veterans

ASJC Scopus subject areas

  • Medicine(all)


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