Comparison of the efficacy and safety of hybrid and sequential therapies as a first-line regimen for Helicobacter pylori infection in Turkey

Introduction Helicobacter pylori infection is a common infection worldwide. The most frequently recommended treatment for eradication of H. pylori remains triple therapy. In this study, we compared sequential and hybrid regimens for H. pylori eradication in a region of Turkey with high resistance to clarithromycin. Material and methods Three hundred and forty H. pylori-positive patients were enrolled in the study. The subjects were randomly divided into two groups. The first group (170 patients) received rabeprazole (40 mg/b.i.d.) and amoxicillin (1000 mg/b.i.d.) for 2 weeks and metronidazole and clarithromycin (500 mg/b.i.d.) during the second week in the hybrid therapy group. The second group (170 patients) received rabeprazole (40 mg/b.i.d.) for 14 days, amoxicillin (1000 mg/b.i.d.) for the first 7 days, and metronidazole plus clarithromycin (each 500 mg/b.i.d.) during the next 7 days in the sequential therapy group. Results In the per-protocol analysis, the eradication rate in the hybrid therapy group was 96.1% (147/153), and in the sequential therapy group it was 90.9% (140/154). There was no significant difference between the two groups (p = 0.06). Ninety-seven of those 340 patients reported minor adverse drug reactions. The percentages of patients with adverse reactions were 30.6% in the hybrid therapy group and 26.5% in the sequential therapy group (p = 0.74). Conclusions Both therapies are highly effective for eradication of H. pylori, and could be recommended as a first-line therapy in regions with high antibiotic resistance.