Ten‐day triple therapy versus sequential therapy versus concomitant therapy as first‐line treatment for H elicobacter pylori infection

Background and Aim Clarithromycin‐based triple therapy ( TT ) is the first‐line treatment for H elicobacter pylori infection in S ingapore. There is awareness that TT may no longer be effective due to increased clarithromycin resistance rates. Sequential therapy ( ST ) and concomitant therapy ( CT ) are alternative treatment regimens. This study aimed to compare the efficacy of 10‐day TT , ST , and CT as first‐line treatment for H . pylori infection. Methods A randomized study conducted in a teaching hospital. Patients aged 21 years and older with newly diagnosed H . pylori infection were randomized to 10‐day TT , ST , or CT . Treatment outcome was assessed by 13‐carbon urea breath test at least 4 weeks after therapy. Intention to treat ( ITT ), modified ITT ( MITT ), and per protocol ( PP ) analyses of the eradication rates were performed. Results A total of 462 patients were enrolled ( ST : 154; TT 155; CT 153). Patient demographics were similar. Eradication rates for ST   versus   TT   versus CT: ITT analysis: 84.4% versus 83.2% versus 81.7% ( P  = not significant [ NS ]); MITT analysis: 90.3% versus 92.1% versus 94.7% ( P  =  NS ); PP analysis: 94.1% versus 92.8% versus 95.4% ( P  =  NS ). Antibiotic resistance rates for amoxicillin, clarithromycin, and metronidazole were 4.7%, 17.9%, and 48.1%, respectively. Dual clarithromycin and metronidazole resistance occurred in 7.5%. Dual resistance and lack of compliance were predictors of treatment failure. Conclusions TT , ST , and CT all achieved eradication rates above 80% on ITT and above 90% on MITT and PP analyses. Dual resistance and lack of compliance were predictors of treatment failure (clinicaltrials.gov: NCT02092506).