TY - JOUR T1 - Sequential therapy for 10 days versus triple therapy for 14 days in the eradication of <em>Helicobacter pylori</em> in the community and hospital populations: a randomised trial JF - Gut JO - Gut SP - 1784 LP - 1792 DO - 10.1136/gutjnl-2015-310142 VL - 65 IS - 11 AU - Jyh-Ming Liou AU - Chieh-Chang Chen AU - Chi-Yang Chang AU - Mei-Jyh Chen AU - Chien-Chuan Chen AU - Yu-Jen Fang AU - Ji-Yuh Lee AU - Tsung-Hua Yang AU - Jiing-Chyuan Luo AU - Jeng-Yih Wu AU - Tai-Cherng Liou AU - Wen-Hsiung Chang AU - Yao-Chun Hsu AU - Cheng-Hao Tseng AU - Chun-Chao Chang AU - Ming-Jong Bair AU - Tzeng-Ying Liu AU - Chun-Fu Hsieh AU - Feng-Yun Tsao AU - Chia-Tung Shun AU - Jaw-Town Lin AU - Yi-Chia Lee AU - Ming-Shiang Wu Y1 - 2016/11/01 UR - http://gut.bmj.com/content/65/11/1784.abstract N2 - Objective Significant heterogeneity was observed in previous trials that assessed the efficacies of sequential therapy for 10 days (S10) versus triple therapy for 14 days (T14) in the first-line treatment of Helicobacter pylori. We aimed to compare the efficacy of S10 and T14 and assess the factors affecting their efficacies.Design We conducted this open-label randomised multicentre trial in eight hospitals and one community in Taiwan. 1300 adult subjects with H pylori infection naïve to treatment were randomised (1:1) to receive S10 (lansoprazole and amoxicillin for the first 5 days, followed by lansoprazole, clarithromycin and metronidazole for another 5 days) or T14 (lansoprazole, amoxicillin and clarithromycin for 14 days). All drugs were given twice daily. Successful eradication was defined as negative 13C-urea breath test at least 6 weeks after treatment. Our primary outcome was the eradication rate by intention-to-treat (ITT) and per-protocol (PP) analyses. Antibiotic resistance was determined by agar dilution test.Results The eradication rates of S10 and T14 were 87.2% (567/650, 95% CI 84.4% to 89.6%) and 85.7% (557/650, 95% CI 82.8% to 88.2%) in the ITT analysis, respectively, and were 91.6% (556/607, 95% CI 89.1% to 93.4%) and 91.0% (548/602, 95% CI 88.5% to 93.1%) in the PP analysis, respectively. There were no differences in compliance or adverse effects. The eradication rates in strains susceptible and resistant to clarithromycin were 90.7% and 62.2%, respectively, for S10, and were 91.5% and 44.4%, respectively, for T14. The efficacy of T14, but not S10, was affected by CYP2C19 polymorphism.Conclusions S10 was not superior to T14 in areas with low clarithromycin resistance.Trial registration number NCT01607918. ER -