Sequential Therapy For Helicobacter Pylori Infection With Tinidazole Efficacy Observation

Objective:To compare the effect of sequential regimen including tinidazole and the standard triple therapy for Helicobacter pylori eradication.The aim is to find out an effective therapy for patients with Helicobacter pylori infection.Methods:Totally 120 Helicobacter pylori-infected patients with peptic ulcer or chronic gastritis diagnosed by endoscopy were enrolled.The patients were randomized divided into two groups,trial group(n=62) who received sequential regimen, pantoprazole 40 mg plus amoxicillin 1.0g for the first 5 days,and followed by pantoprazole 40 mg,clarithromycin 500 mg and tinidazole 500 mg,for the last 5 days; and control group(n=58) who received standard triple regimen,pantoprazole 40 mg, clarithromycin 500 mg and amoxicillin 1 g,for 7 days.All drugs were given twice daily. After finishing of H.pylori therapy at least four weeks later,and after withdrawal of pantoprazole at least two weeks later,we compared the H.pylori status,ulcer healing, clinical symptoms and side-effects among two groups by inquisition,endoscopy and ¹³C-urea breath test(¹³C-UBT).Two regimens were evaluated by cost effectiveness analysis and factors affecting the rate of H.pylori eradication were filtered by logistic regression analysis.Results:1.The eradication rate of the trial group was significantly greater than that of the control group in the intention-to-treat analysis(83.83%vs.67.20%;P＜0.05; difference),and the per-protocol analysis(89.71%vs.72.21%;P＜0.05;difference).2.The peptic ulcer healing rates,the clinical symptom remission rates and the incidence of adverse reactions were not different significantly beteen two groups (p＞0.05).3.The cost effectiveness analysis showed that the C/E value of the trial group were lower than the control group.4.Multiple regression analysis identified that the H.pylori eradication rate correlated to age,the history of peptic ulcer and H.pylori tissue staining outcome,but not to sex, body mass index(BMI),smoking and drinking habit.Overall eradieation rate was higher in older patients(≥50years) and tissue staining results that were positive but without a history of PU.Conclusion:1.The 10 - day sequential therapy comprising tinidazole can achieve a higher eradication rate of H.pylori.2.The eradication rate of H.pylori is higher in older patients(≥50 years) without a history of PU and with tissue staining results that were positive before primary treatment.