Sequential therapy also cured significantly more patients harboring strains resistant only to clarithromycin than triple therapy (p = .0216). Five randomized trials took place comparing sequential therapy to standard therapy across three countries. Although sequential therapy is thought to be especially useful in overcoming this website clarithromycin resistance, a study from China showed that this may be negated when dual clarithromycin and metronidazole resistance is present [19]. In this study, there was no significant difference between the eradication rates achieved with standard triple therapy (66.4%)

and sequential (72.1%) in either the ITT or the PP analysis. Sequential therapy achieved significantly higher eradication rates (88.8%; 95% CI: 51.7–88.7) than triple therapy (43.7%; 95% CI: 19.7–70) in patients harboring strains resistant only to clarithromycin. However, in patients harboring strains resistant

to clarithromycin and metronidazole, neither treatment was able to reach an eradication rate >55%. In Morocco, two randomized studies were performed comparing sequential to standard therapy. In both, sequential therapy performed impressively against standard triple, with ITT eradication rates of 65.9% in the standard triple therapy group and 82.8 in the sequential therapy group in one, and 94.2% for sequential and 70% for metronidazole-based triple therapy and 78% for clarithromycin-based

triple in the other [20, 21]. Another two randomized, DNA Damage inhibitor prospective studies carried out in India also showed significantly better eradication rates for sequential therapy [22, 23]. One study on patients with all causes of dyspepsia showed an advantage for sequential MCE公司 therapy with an ITT eradication rate of 88.2 vs 79.1% for triple [22]. A second study looking at patients with documented peptic ulcer disease also found sequential therapy superior although the raw ITT eradication rates were less impressive (76.0 vs 61.9%) [23]. Three meta-analyses examining the efficacy of sequential versus standard triple therapy in Asia were also published this year, all of which favored sequential therapy. One included all studies with Asian adults and reported a pooled RR of 1.1 for eradication with sequential therapy over standard triple with an NNT of 14 [24]. In a second meta-analysis limited to nine studies conducted in Asia, the odds ratio (OR) for eradication of H. pylori with sequential therapy over standard triple was 1.8 [25]. A further meta-analysis of Korean studies only also favored of sequential therapy with an OR of 1.8 [26]. Concomitant therapy was evaluated in one article published this year from an area of high antibiotic resistance and found to have an ITT eradication rate in first-line therapy of 91.5 and 60.6% as second therapy [27].