Why carry out the study?

One of the main reasons for the decreasing efficacy of Helicobacter pylori eradication is related to the increasing incidence of clarithromycin-resistant strains of H. pylori. Searching for successful treatment regimens in areas with increasing clarithromycin resistance > 15%, especially those with dual resistance to clarithromycin and metronidazole, is mandatory.

Fourteen days’ hybrid therapy has been successful in the presence of clarithromycin resistance. It achieves an eradication rate of > 95% by intention-to-treat (ITT) and per-protocol (PP) analysis in areas of high clarithromycin and metronidazole resistance. However, it involves multiple drugs and prescription is complex, involving two stages of different drugs.

What was learned from the study?

High-dose dual therapy (proton-pump-inhibitor plus amoxicillin) involves a more potent acid inhibitor that likely enhances the activity of amoxicillin and is a promising alternative that can decrease misuse of antibiotics. HDDT can attain acceptable eradication rates if optimal doses, timing and treatment duration are applied but is still not categorized as strongly recommended in many consensus statements (< 90% eradication rates in many studies).

This study demonstrated that 14-day rabeprazole-containing HDDT did not achieve > 90% eradication rates for first-line H. pylori eradication as 14-day rabeprazole-containing HT did. HDDT is a potentially beneficial combination, which involves only two drugs with mild adverse effects; more precise studies are urged to find answers regarding these failures.