A recent systematic review and meta-analysis indicated that when it comes to eradicating Helicobacter pylori (H. pylori), sequential therapy (ST) may be more effective than standard triple therapy (TT), especially in cases where there is a high prevalence of clarithromycin resistance. The investigators aimed to evaluate the tolerability and efficacy of ST when used as the major treatment for H. pylori infection, compared to the standard TT. To identify relevant studies, the researchers initially identified 2,045 articles from various databases, removing 511 duplicate records.

After carefully reviewing the titles and abstracts, they selected 20 publications for a full-text review, with 15 articles meeting the eligibility criteria. In the study, the ST involved a treatment plan spanning 10 days. It began with a 5-day course of a proton-pump inhibitor (PPI) and Amoxicillin, followed by an additional 5-day course with PPI, clarithromycin (500 mg twice per day), and nitroimidazole (either 400 mg or 500 mg). On the other hand, the TT incorporated a regimen lasting at least 7 days, which included PPI, clarithromycin (500 mg twice daily), and Amoxicillin (1 g twice daily).

ST was promising as a primary treatment for eliminating H. pylori, particularly in instances where clarithromycin resistance is a concern, and longer ST durations appear to result in more favorable results. Furthermore, ST might present cost-effective benefits and similar treatment adherence when compared to TT. Nonetheless, researchers stress the importance of conducting additional studies to address any remaining limitations and to comprehensively evaluate the long-term effectiveness and safety of ST.