[ { "key": "T9FTPFE4", "version": 1, "library": { "type": "group", "id": 38885, "name": "ERGE 2011", "links": { "alternate": { "href": "https://www.zotero.org/groups/erge_2011", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/38885/items/T9FTPFE4", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/erge_2011/items/T9FTPFE4", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/38885/items/8RD3AI74", "type": "application/json" } }, "meta": { "createdByUser": { "id": 522846, "username": "dr.juanjose.gonzalez", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dr.juanjose.gonzalez", "type": "text/html" } } } }, "data": { "key": "T9FTPFE4", "version": 1, "parentItem": "8RD3AI74", "itemType": "attachment", "linkMode": "linked_url", "title": "Snapshot", "accessDate": "2011-03-12T13:36:13Z", "url": "http://www.annals.org/content/146/8/556.abstract", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2011-03-12T13:36:13Z", "dateModified": "2011-03-12T13:36:13Z" } }, { "key": "8RD3AI74", "version": 1, "library": { "type": "group", "id": 38885, "name": "ERGE 2011", "links": { "alternate": { "href": "https://www.zotero.org/groups/erge_2011", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/38885/items/8RD3AI74", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/erge_2011/items/8RD3AI74", "type": "text/html" } }, "meta": { "createdByUser": { "id": 522846, "username": "dr.juanjose.gonzalez", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dr.juanjose.gonzalez", "type": "text/html" } } }, "creatorSummary": "Vaira et al.", "parsedDate": "2007", "numChildren": 2 }, "data": { "key": "8RD3AI74", "version": 1, "itemType": "journalArticle", "title": "Sequential Therapy versus Standard Triple-Drug Therapy for Helicobacter pylori Eradication", "creators": [ { "creatorType": "author", "firstName": "Dino", "lastName": "Vaira" }, { "creatorType": "author", "firstName": "Angelo", "lastName": "Zullo" }, { "creatorType": "author", "firstName": "Nimish", "lastName": "Vakil" }, { "creatorType": "author", "firstName": "Luigi", "lastName": "Gatta" }, { "creatorType": "author", "firstName": "Chiara", "lastName": "Ricci" }, { "creatorType": "author", "firstName": "Federico", "lastName": "Perna" }, { "creatorType": "author", "firstName": "Cesare", "lastName": "Hassan" }, { "creatorType": "author", "firstName": "Veronica", "lastName": "Bernabucci" }, { "creatorType": "author", "firstName": "Andrea", "lastName": "Tampieri" }, { "creatorType": "author", "firstName": "Sergio", "lastName": "Morini" } ], "abstractNote": "Background: Antimicrobial resistance has decreased eradication rates for Helicobacter pylori infection worldwide.Objective: To determine whether sequential treatment eradicates H. pylori infection better than standard triple-drug therapy for adults with dyspepsia or peptic ulcers.Design: Randomized, double-blind, placebo-controlled trial.Setting: Two Italian hospitals between September 2003 and April 2006.Patients: 300 patients with dyspepsia or peptic ulcers.Measurements: 13C-urea breath test, upper endoscopy, histologic evaluation, rapid urease test, bacterial culture, and assessment of antibiotic resistance.Intervention: A 10-day sequential regimen (40 mg of pantoprazole, 1 g of amoxicillin, and placebo, each administered twice daily for the first 5 days, followed by 40 mg of pantoprazole, 500 mg of clarithromycin, and 500 mg of tinidazole, each administered twice daily for the remaining 5 days) or standard 10-day therapy (40 mg of pantoprazole, 500 mg of clarithromycin, and 1 g of amoxicillin, each administered twice daily).Results: The eradication rate achieved with the sequential regimen was significantly greater than that obtained with the standard treatment in the intention-to-treat analysis (89% vs. 77%; P = 0.0134; difference, 12% [95% CI, 3% to 20%]), the modified intention-to-treat analysis (91% vs. 78%; P = 0.0022; difference, 13% [CI, 5% to 21%]), and the per-protocol analysis (93% vs. 79%; P = 0.0013; difference, 14% [CI, 6% to 21%]). Sequential therapy was significantly more effective in patients with clarithromycin-resistant strains (89% vs. 29%; P = 0.0034). The incidence of major and minor side effects did not differ between therapy groups (17% in both groups). One patient (0.7%) in the standard therapy group discontinued treatment because of side effects.Limitations: Follow-up was incomplete in 4.6% and 2.7% patients in the sequential therapy and standard therapy groups, respectively. The results may not be generalizable to other countries. Sequential therapy may be more effective because it includes 1 additional antibiotic (tinidazole) that is not contained in standard therapy.Conclusions: Sequential therapy is statistically significant compared with standard therapy for eradicating H. pylori infection and is statistically significantly more effective in patients with clarithromycin-resistant strains. Side effects are similar with both treatment regimens and are rarely severe enough to cause discontinuation of therapy. 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