Utilizing an optimized sequential regimen for 14 days with Rabeprazole can achieve comparable eradication rates to non-bismuth quadruple concomitant therapy, with fewer adverse events and greater cost-effectiveness.

The global challenge of Helicobacter pylori (H. pylori) cure persists amid rising antimicrobial resistance. Optimizing sequential therapy, particularly with new-generation proton-pump inhibitors (PPIs), offers an effective and cost-efficient treatment.

To compare the effectiveness, adverse event rates, and cost of an optimized sequential therapy and standard non-bismuth quadruple treatment lasting 10 and 14 days.

In this prospective open-label study, 328 patients diagnosed with H. pylori infection were randomized to 3 groups (1:1:1):

• First group (QT-10): 10-day quadruple therapy with Omeprazole 20 mg + Amoxicillin 1 g + Clarithromycin 500 mg + Metronidazole 500 mg given twice-daily
• Second group (QT-14): Same as the first group but for 14 days
• Third group (OST-14): Optimized sequential treatment with Rabeprazole 20 mg + Amoxicillin 1 g twice daily initially for a week, then Rabeprazole 20 mg twice daily, finally Clarithromycin 500 mg twice daily + Metronidazole 500 mg for the next 7 days

Adverse events were recorded throughout the study. A 13C urea breath test was used to determine the H. pylori infection eradication rate about 4 to 6 weeks after the treatment.

The H. pylori eradication rate was higher in the OST-14 group (93.5%, 85.5% P = 0.04) than QT-10 group (96.2%, 89.5% P = 0.03) in the intention-to-treat and per-protocol analysis. On the other hand, no statistically noteworthy difference in eradication rates between the second and third groups was found. Patients in the OST-14 group had considerably fewer adverse events and was the most cost-effective therapy among the three.

The optimized 14-day sequential therapy is a safe and efficacious alternative, exhibiting eradication rates comparable to 14-day concomitant therapy.