Abstract
The challenges posed in the treatment of Helicobacter pylori are increasing: falling rates of eradication and the rising prevalence of antibiotic-resistant H. pylori strains have led to a decline in cure rates. Sequential therapy has been proposed as an alternative to standard triple therapy. The fundamental basis of sequential therapy lies in its superior ability to overcome antibiotic resistance, particularly clarithromycin resistance. The meta-analysis by Jafri et al. shows a potential benefit from using this treatment regimen, but several methodological and practical limitations affect the strength of their conclusions. Greater scrutiny and better designed trials across a much broader range of patients are necessary before guidelines could be supplanted. An expanded role for culture and sensitivity testing might offer the best long-term prospect for the management of H. pylori infection, rather than empirical regimens.
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References
Malfertheiner P et al. (2007) Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 56: 772–781
Vakil N et al. (2004) Seven-day therapy for Helicobacter pylori in the United States. Aliment Pharmacol Ther 20: 99–107
Jafri NS et al. (2008) Meta-analysis: sequential therapy appears superior to standard therapy for Helicobacter pylori infection in patients naive to treatment. Ann Intern Med 148: 923–931
Chisholm SA et al. (2007) Surveillance of primary antibiotic resistance of Helicobacter pylori at centres in England and Wales over a six-year period (2000–2005) Euro Surveill 12: E3–E4
Graham DY and Shiotani A (2008) New concepts of resistance in the treatment of Helicobacter pylori infections. Nat Clin Pract Gastroenterol Hepatol 5: 321–331
Lee M et al. (1999) A randomized controlled trial of an enhanced patient compliance program for Helicobacter pylori therapy. Arch Intern Med 159: 2312–2316
Graham DY et al. (1992) Factors influencing the eradication of Helicobacter pylori with triple therapy. Gastroenterology 102: 493–496
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CA O'Morain is a Consultant for Abbott, Schering-Plough and Shire. He has also received grant/research support from Abbott and Schering-Plough. JPA O'Connor declared no competing interests.
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O'Morain, C., O'Connor, J. Is sequential therapy superior to standard triple therapy for the treatment of Helicobacter pylori infection?. Nat Rev Gastroenterol Hepatol 6, 8–9 (2009). https://doi.org/10.1038/ncpgasthep1276
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DOI: https://doi.org/10.1038/ncpgasthep1276