Sequential Therapy for H. pylori Eradication

Standard triple therapy for Helicobacter pylori infection consists of a proton-pump inhibitor and two antibiotics, administered simultaneously. Increasing resistance to two commonly used antibiotics, metronidazole and clarithromycin, has decreased the efficacy of this approach to less than 80% in North America and Europe. Small studies have suggested that sequential, rather than simultaneous, antibiotic therapy might improve eradication rates. Researchers explored this possibility in a double-blind study that involved 300 adults in Italy with dyspepsia or peptic ulcers.

Participants were evaluated by endoscopy (with biopsies for histologic evaluation, culture, and urease testing) and by urea breath testing to confirm H. pylori infection. The…