Korean J Gastroenterol.  2019 Feb;73(2):99-104. 10.4166/kjg.2019.73.2.99.

Eradication Rates of 10-day Sequential Therapy for Helicobacter pylori: Results of an 8-year Prospective Study Conducted at a Tertiary Korean Hospital

• Yoon K
• Kim N

• KMID: 2438709
• DOI: http://doi.org/10.4166/kjg.2019.73.2.99

Abstract

BACKGROUND/AIMS
The Helicobacter pylori (H. pylori) eradication rate of standard triple therapy is unsatisfactory in Korea, and sequential therapy (SQT) has been suggested to be a practical first-line alternative regimen. The aim of this prospective study was to document changes in annual eradication rates of SQT.
METHODS
A total of 983 H. pylori-positive subjects were enrolled from 2010 to 2018 and their data were subjected to intention-to-treat (ITT) and per-protocol (PP) analysis. All subjects received 10-day sequential therapy consisting of 40 mg esomeprazole and 1 g amoxicillin b.i.d for 5 days followed by 40 mg esomeprazole b.i.d, 500 mg clarithromycin b.i.d and 500 mg metronidazole t.i.d for 5 days. The 13C-urea breath test, rapid urease test (CLO test®), and histology were used to confirm eradication. Compliance and side effects were also investigated.
RESULTS
ITT and PP eradication rates of SQT were 69.9% (687 of 983) and 87.1% (657 of 754), respectively. The annual eradication rate of ITT remained consistent over the 8-year study period (p for trend=0.167), whereas PP analysis showed the eradication rate increased (p for trend=0.042). The overall adverse event rate for SQT was 41.7% (410 subjects).
CONCLUSIONS
Despite high antibiotic resistance rates in Korea, the eradication rate of SQT did not decrease over the 8-year study period.

Keyword

Helicobacter pylori; Sequential therapy; Intention to treat analysis; Per-protocol analysis

MeSH Terms

Amoxicillin
Breath Tests
Clarithromycin
Compliance
Drug Resistance, Microbial
Esomeprazole
Helicobacter pylori*
Helicobacter*
Intention to Treat Analysis
Korea
Metronidazole
Prospective Studies*
Urease
Amoxicillin
Clarithromycin
Esomeprazole
Metronidazole
Urease

Figure

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  Fig. 1 Schematic of the analysis.

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  Fig. 2 Intention-to-treat (ITT) and per-protocol (PP) analysis of annual Helicobacter pylori eradication rate following 10-day sequential therapy. ITT eradication rates remained constant over the study period (p for trend=0.167), whereas PP eradication rates showed a significant increasing trend (p for trend=0.042).

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