Abstract
BackgroundMost international guidelines recommend triple-therapy regimens consisting of a proton pump inhibitor, clarithromycin, and amoxicillin/metronidazole for at least 7 days for the eradication of Helicobacter pylori. However, the efficacy of 7-day clarithromycin-based standard triple therapy for H. pylori infection is currently unacceptable in Korea. In this study, we will compare the efficacy and safety of 7-day standard triple therapy, 10-day sequential therapy, and 10-day concomitant therapy for the first-line treatment of H. pylori infection in Korea.Methods/designIn this multicenter, investigator-blinded, randomized trial we are recruiting adult patients with H. pylori infection from 15 hospitals in Korea to determine whether sequential or concomitant treatment is superior to standard triple therapy. Patients are randomly assigned to receive either standard triple therapy (lansoprazole, amoxicillin, and clarithromycin) for 7 days, or sequential treatment (lansoprazole and amoxicillin for the first 5 days, followed by lansoprazole, clarithromycin, and metronidazole for another 5 days) for 10 days, or concomitant therapy (lansoprazole, amoxicillin, clarithromycin, and metronidazole) for 10 days. The primary outcome is the rate of H. pylori eradication in the intention-to-treat population.DiscussionThe results of this study will be crucial for determining the optimal regimen for the primary treatment of H. pylori infection in Korea. This study will produce vital evidence that will lead to revisions to guidelines concerning first-line treatment regimens for H. pylori infection.Trial registrationClinical Research Information Service (CRIS), Republic of Korea, KCT0001980. Registered on 25 July 2016.
Highlights
Most international guidelines recommend triple-therapy regimens consisting of a proton pump inhibitor, clarithromycin, and amoxicillin/metronidazole for at least 7 days for the eradication of Helicobacter pylori
This study will produce vital evidence that will lead to revisions to guidelines concerning first-line treatment regimens for H. pylori infection
A recent study using a nationwide Korean database demonstrated that the eradication rate of clarithromycin-based standard triple therapy is 73% [9]
Summary
The Korean College of Helicobacter and Upper Gastrointestinal Research proposed revised guidelines in 2013 [10, 28] These revised guidelines recommend standard triple therapy including a conventional PPI, clarithromycin, and amoxicillin as the primary eradication regimen with a high level of evidence and strong recommendation grade. Only this regimen is reimbursed by the Korean government and health insurance system. This appeared to be caused by the amount of macrolide antibiotic used [30] In this respect, clinical guidelines for H. pylori eradication should be modified on the basis of results of a nationwide trial, given the variation in eradication rates after standard triple therapy in each region.
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