Modified Sequential Helicobacter pylori Therapy: Proton Pump Inhibitor and Amoxicillin for 14 Days with Clarithromycin and Metronidazole added as a Quadruple (Hybrid) Therapy for the Final 7 Days

Background: Ten-day sequential therapy with a proton pump inhibitor (PPI) and amoxicillin followed by a PPI, clarithromycin, and an imidazole typically achieves Helicobacter pylori eradication rates of 90–94% (Grade B success).

Aims: We tested whether prolonging treatment and continuing amoxicillin throughout the 14-day treatment period would produce a ≥95% result.

Methods: This was a multicenter pilot study in which H. pylori-infected patients received a 14-day sequential–concomitant hybrid therapy (esomeprazole and amoxicillin for 7 days followed by esomeprazole, amoxicillin clarithromycin, and metronidazole for 7 days). H. pylori status was examined 8 weeks after therapy. Success was defined as achieving ≥95% eradication by per-protocol analysis.

Results: One hundred and seventeen subjects received hybrid therapy. The eradication rate was 99.1% (95% confidence interval (CI), 97.3–100.0%) by per-protocol analysis and 97.4% by intention-to-treat analysis (95% CI, 94.5–100.0%). Adverse events were seen in 14.5%; drug compliance was 94.9%.

Conclusions: Fourteen-day hybrid sequential–concomitant therapy achieved >95%H. pylori eradication (Grade A result). Further studies are needed 1, in regions with different patterns and frequencies of resistance to confirm these findings, and 2, to examine whether Grade A success is maintained with hybrid therapy shorter than 14 days.