14-day triple, 5-day concomitant, and 10-day sequential therapies for Helicobacter pylori infection in seven Latin American sites: a randomised trial.

Publication Type:

Journal Article


Lancet, Volume 378, Issue 9790, p.507-14 (2011)


2-Pyridinylmethylsulfinylbenzimidazoles, 2011, Adult, Aged, Amoxicillin, Anti-Bacterial Agents, Breath Tests, Center-Authored Paper, Clarithromycin, Drug Administration Schedule, Drug Therapy, Combination, Female, Helicobacter Infections, Helicobacter pylori, Humans, Latin America, Male, Metronidazole, Middle Aged, Proton Pump Inhibitors, Public Health Sciences Division, September 2011, Time Factors, Treatment Outcome, Urea


Evidence from Europe, Asia, and North America suggests that standard three-drug regimens of a proton-pump inhibitor plus amoxicillin and clarithromycin are significantly less effective for eradication of Helicobacter pylori infection than are 5-day concomitant and 10-day sequential four-drug regimens that include a nitroimidazole. These four-drug regimens also entail fewer antibiotic doses than do three-drug regimens and thus could be suitable for eradication programmes in low-resource settings. Few studies in Latin America have been done, where the burden of H pylori-associated diseases is high. We therefore did a randomised trial in Latin America comparing the effectiveness of four-drug regimens given concomitantly or sequentially with that of a standard 14-day regimen of triple therapy.