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Efficacy, Tolerability, and Factors Affecting the Efficacy of the Sequential Therapy in Curing Helicobacter Pylori Infection in Clinical Setting
  1. Antonio Tursi, MD*,
  2. Walter Elisei, MD,
  3. GianMarco Giorgetti, MD,
  4. Marcello Picchio, MD§,
  5. Giovanni Brandimarte, MD
  1. From the *Gastroenterology Service, ASL BAT, Andria (BAT); †Division of Gastroenterology, ASL Roma H, Albano Laziale; ‡Digestive Endoscopy and Nutrition Unit, "S. Eugenio" Hospital; §Division of General Surgery, "C. Colombo" Hospital, ASL RMH, Velletri; and ∥Division of Gastroenterology, "Cristo Re" Hospital, Rome, Italy.
  1. Received February 6, 2011, and in revised form February 23, 2011.
  2. Accepted for publication February 23, 2011.
  3. Reprints: Antonio Tursi, MD, Servizio di Gastroenterologia Territoriale, DSS n°4, ASL BAT, Via Torino, 49, 70031 Andria, Italy. E-mail: antotursi{at}
  4. Disclosure of funding received: This work did not receive any fund from any organization, including the National Institutes of Health, Wellcome Trust, and Howard Hughes Medical Institute.


Background Sequential therapy is currently suggested as first-line therapy in curing Helicobacter pylori infection, but results coming from its use in clinical practice are scarce. We evaluated the efficacy of this therapy regimen in our current clinical practice.

Methods A retrospective study was conducted on 437 consecutive dyspeptic patients with proven H. pylori infection. Patients received a 10-day sequential therapy with proton pump inhibitor (PPI) plus amoxicillin 1 g for the first 5 days, followed by PPI, clarithromycin 500 mg, and tinidazole 500 mg for the remaining 5 days (all twice daily) plus PPI every day for further 4 weeks in case of active peptic ulcer or severe gastritis detected at endoscopy. One month after conclusion of therapy, endoscopy was performed in those patients for whom the examinations were clinically relevant. The remaining patients were checked by 13C-urea breath test.

Results Three-hundred ninety-eight patients (91.08%; 95% confidence interval [CI], 87.91%-93.50%) were fully compliant, 19 patients (4.35%; 95% CI, 2.71%-6.83%) took less than 80% of the prescribed drugs, 11 patients (2.52%; 95% CI, 1.33%-4.60%) were withdrawn because of side effects, and 9 patients (2.06%; 95% CI, 1.01%-4.01%) were lost to follow-up. The H. pylori eradication was obtained in 395 (90.39%, 95% C.I. 87.14% to 92.91%) of 437 and in 362 of 437 (82.84%, 95% C.I. 78.90% to 86.19%) as per-protocol and intention-to-treat analyses, respectively.

Conclusions Sequential regimen seems to be a valid therapeutic strategy for the management of H. pylori infection in clinical practice.

Key Words
  • antibiotics
  • Helicobacter pylori
  • proton pump inhibitors
  • sequential therapy
  • treatment

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