Sequential or concomitant therapy for eradication of Helicobacter pylori infection: A systematic review and meta-analysis

J Gastroenterol Hepatol. 2015 Sep;30(9):1338-45. doi: 10.1111/jgh.12984.


Background and aim: Eradication of Helicobacter pylori (H. pylori) infection with triple therapy (TT) has declined in many countries prompting the search for alternative regimens. Sequential therapy (ST) and concomitant therapy (CT) have been suggested as first-line regimens in areas of high clarithromycin resistance. We performed a meta-analysis to compare the eradication rates of CT with ST for H. pylori.

Methods: A comprehensive literature search for studies comparing the efficacy of CT with ST was performed. Dichotomous data were pooled to obtain the odds ratio (OR) of the eradication rate with 95% confidence intervals (CIs). The eradication rates were considered both on an intention-to-treat (ITT) and on a per-protocol (PP) bases.

Results: A total of 7 studies provided data on 2412 adult patients. Pooled estimates of the studies revealed no significant differences between CT and ST. The pooled OR was 1.116 (95% CI: 0.795-1.567, P = 0.526) for ITT analysis and 1.153 (95% CI: 0.793-1.677, P = 0.455) for PP analysis. There was no difference in the rate of adverse events (OR: 1.229, 95% CI: 0.971-1.556, P = 0.086) and compliance (OR: 0.945, 95% CI: 0.722-1.237, P = 0.681) between the two regimens. Subgroup analysis was performed to compare CT of 10 days and 5 days with ST of 10 days. The pooled OR was 1.518 for CT of 10 days and 0.636 for CT of 5 days.

Conclusions: CT regimens did not achieve higher eradication rates compared with the ST regimen. The adverse events and adherence to medications were not different between the two regimens.

Keywords: Helicobacter pylori; concomitant therapy; meta-analysis; sequential therapy.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Amoxicillin / administration & dosage
  • Anti-Bacterial Agents / administration & dosage
  • Clarithromycin / administration & dosage
  • Databases, Bibliographic
  • Drug Therapy, Combination
  • Gastritis / drug therapy*
  • Gastritis / microbiology*
  • Helicobacter Infections*
  • Helicobacter pylori*
  • Humans
  • Metronidazole / administration & dosage
  • Proton Pump Inhibitors / administration & dosage
  • Rho Guanine Nucleotide Exchange Factors / metabolism
  • Treatment Outcome


  • ARHGEF5 protein, human
  • Anti-Bacterial Agents
  • Proton Pump Inhibitors
  • Rho Guanine Nucleotide Exchange Factors
  • Metronidazole
  • Amoxicillin
  • Clarithromycin