Ciprofloxacin-containing versus clarithromycin-containing sequential therapy for Helicobacter pylori eradication: A randomized trial

Helicobacter pylori eradication rates with standard triple therapy have declined to unacceptable levels. This randomized trial aimed at evaluating the efficacy of a ciprofloxacin containing sequential regimen in the eradication of H. pylori-infected patients vs. a clarithromycin containing sequential therapy. A total of 212 patients were randomized into 14-day therapeutic schemes (106 patients per group): (1) clarithromycin-containing sequential therapy rabeprazole plus amoxicillin for 7 days, followed by rabeprazole plus clarithromycin plus metronidazole for 7 days, and (2) ciprofloxacin-containing sequential therapy using ciprofloxacin instead of clarithromycin. Eradication was confirmed by stool H. pylori antigen. Adverse effects and compliance were assessed by a questionnaire. Per protocol cure rates were as follows: 87.6 % in the ciprofloxacin-containing sequential therapy and 76 % in the clarithromycin group. Intention-to-treat cure rates were as follows: 73.5 % for the ciprofloxacin group and 66 % for the clarithromycin group. No differences in compliance or adverse effects were demonstrated among treatments. Ciprofloxacin-containing sequential therapy is more effective and equally safe compared to a clarithromycin-containing sequential therapy.