h pylori therapy sequential vs standard therapies
I previously sent out an article finding that sequential H pylori therapy (5 days of PPI plus amoxicillin 1 g twice a day, followed by 5 days of PPI plus clarithromycin 500 twice a day plus metronidazole 500 twice a day) was superior to standard triple therapy. This sequential therapy worked even with clarithromycin resistance, with 89% of clarithromycin-resistant strains responding vs 29% with standard therapy. they posited the mechanism for resistance being that h pylori developed efflux channels for clarithro that rapidly remove the drug from the bacteria and that amox changes the structure of the cell membrane to prevent effective clarithromycin efflux and therefore resistance. (see hpylori rx sequential annals 2007 in dropbox, or Ann Intern Med 2007; 146:555-563) there was a recent systematic review and meta-analysis in the BMJ assessing the efficacy of sequential versus triple therapy ( see hpylori rx sequential metaanal bmj 2013 in drop...