review article on safety and efficacy of sequential versus triple therapies for treating h. pylori infection

Author Name: manisha aryal, sanjila lamgade

Abstract: background : standard triple therapy (stt), sequential therapy (sqt) and bismuth based quadruple therapy are among the therapeutic regimen available for the initial management of the h.pylori infection. the goal of therapy is to eradicate h. pylori and is usually initiated with standard triple-drug therapy. during the past few years, with increased in bacterial resistance with time, the efficacy of triple therapy has decreased of less than 80% rate of eradication. several recent meta-analysis have shown higher eradication rates with sequential therapy regimens than the standard triple therapy. objective : the objective of review study was to compare safety and efficacy evaluation of sequential versus triple therapy in h. pylori infection. method: an electronic search was conducted in pubmed, google, google scholar, ,medline and science direct. our search strategy was based on key terms; “helicobacter pylori”, “standard triple therapy”, “sequential therapy”, “ppi”. the review was limited to english language and randomized clinical trials (rcts) and published between 2007 to 2015. inclusion criteria were a study conducted in adult aged 18 years and above having hp infection and receiving sequential therapy and standard triple therapy. non-randomized studies, studies done in children and studies covering the retreatment after eradication failure were omitted from the study. result: the review comprised 12 rcts studies, with 10 of them reporting higher eradication rate with sequential therapy. due to clarithromycin resistance, the review conforms that the stt have poor success rate of infection eradication. according to some studies finding, sequential treatment containing levofloxacin is found to be effective for patients who failed from either sequential therapy containing clarithromycin or triple therapy. conclusion : in conclusion, sequential therapy is well tolerated and provides a higher eradication rate than 14- day standard triple therapy in the treatment of h.pylori infection. assessment of resistance rate is crucial in order to guide treatment and hence it should be performed. in addition, estimating the cost-effectiveness of these treatments is crucial in clinical decision making, especially in the area with high prevalence rate of infection.

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