Optimized sequential therapy vs 10- and 14-d concomitant therapy for eradicating Helicobacter pylori: A randomized clinical trial

作     者：Hassan Seddik Jihane Benass Sanaa Berrag Asmae Sair Reda Berraida Hanae Boutallaka 

作者机构：Department of Gastroenterology IIMohammed V Military Teaching Hospital of RabatRabat 10100Morocco Department of GastroenterologyMohammed V University in RabatRabat 10100Morocco Department of Gastroenterology IMohammed V Military Teaching Hospital of RabatRabat 10100Morocco 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2024年第30卷第6期

页      面：556-564页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Helicobacter pylori Quadruple therapy Sequential Proton-pump inhibitor Optimization 

摘      要：BACKGROUND A cure for Helicobacter pylori(***)remains a problem of global *** prevalence of antimicrobial resistance is widely rising and becoming a challenging issue *** sequential therapy seems to be one of the most attractive strategies in terms of efficacy,tolerability and *** most common sequential therapy consists of a dual therapy[proton-pump inhibitors(PPIs)and amoxicillin]for the first period(5 to 7 d),followed by a triple therapy for the second period(PPI,clarithromycin and metronidazole).PPIs play a key role in maintaining a gastric pH at a level that allows an optimal efficacy of antibiotics,hence the idea of using new generation *** open-label prospective study randomized 328 patients with confirmed *** infection into three groups(1:1:1):The first group received quadruple therapy consisting of twice-daily(bid)omeprazole 20 mg,amoxicillin 1 g,clarith-romycin 500 mg and metronidazole 500 mg for 10 d(QT-10),the second group received a 14 d quadruple therapy following the same regimen(QT-14),and the third group received an optimized sequential therapy consisting of bid rabe-prazole 20 mg plus amoxicillin 1 g for 7 d,followed by bid rabeprazole 20 mg,clarithromycin 500 mg and metronidazole 500 mg for the next 7 d(OST-14).AEs were recorded throughout the study,and the *** eradication rate was determined 4 to 6 wk after the end of treatment,using the 13C urea breath *** In the intention-to-treat and per-protocol analysis,the eradication rate was higher in the OST-14 group compared to the QT-10 group:(93.5%,85.5%P=0.04)and(96.2%,89.5%P=0.03)***,there was no statist-ically significant difference in eradication rates between the OST-14 and QT-14 groups:(93.5%,91.8%P=0.34)and(96.2%,94.4%P=0.35),*** overall incidence of AEs was significantly lower in the OST-14 group(P=0.01).Furthermore,OST-14 was the most cost-effective among the three *** The optimized 14-