Efficacy of High Dose Dual Therapy, Sequential Therapy and Triple Therapy in H. Pylori Eradication
Efficacy of High Dose Dual Therapy, Sequential Therapy and Triple Therapy in H. Pylori Eradication
Up to now, to our knowledge, there is few randomized, large scale study prospectively and
 simultaneously comparing the efficacy, adverse effects and patient adherence of these current
 recommended 1st-line or 2nd-line regimens for H. pylori eradication in and out of our
 country.

 The aims of this study are:

 1. to compare the efficacy of high dose dual therapy, sequential therapy and
 clarithromycin-based triple therapy as 1st-line regimen in H. pylori eradication;

 2. to compare the efficacy of high dose dual therapy, sequential therapy and
 levofloxacin-based triple therapy as rescue regimen in H. pylori eradication;

 3. to compare the patient adherence and adverse effects of these treatment regimens;

 4. to investigate factors that may influence H. pylori eradication by these treatment
 regimens;

 5. to investigate and analyze the prevalence and trend of antibiotic resistance.
Patients having H. pylori-positive chronic gastritis with/without peptic ulcers will be
 recruited. All undergo endoscopy with biopsy before treatment. Four to eight weeks after
 termination of treatment, H. pylori infection status will be examined by endoscopy with
 biopsy or the Carbon 13-urea breath test if the patients refuse the second endoscopy. The
 cytochrome P450 (CYP) 2C19 genotype of each participant will be analyzed by the polymerase
 chain reaction-based restriction fragment length polymorphism (PCR-RFLP) method. A computed
 generated random numbers sequence will be blocked into three subgroups, say A1, B1 and C1 (or
 A2, B2, and C2).

 If the patients did not receive anti-H. pylori therapy previously, they will be invited to
 enter the first part of study for evaluating the efficacy of 1st-line regimens. If the
 patients had received anti-H. pylori therapy previously, they will be invited to enter the
 second part of study for evaluating the efficacy of rescue regimens. Patients who meet the
 inclusion criteria and do not have any one of the exclusion criteria will be randomized to
 receive one of the following regimens:

 -  for 1st-line regimens: group A1 - high dose dual therapy (rabeprazole 20 mg qid +
 amoxicillin 750 mg qid for 14 days); group B1 - sequential therapy (rabeprazole 20 mg +
 amoxicillin 1000 mg, bid for 5 days, then rabeprazole 20 mg + metronidazole 500 mg +
 clarithromycin 500 mg, bid for next 5 days); group C1 - clarithromycin-based triple
 therapy (rabeprazole 20 mg + amoxicillin 1000 mg + clarithromycin 500 mg, bid for 7
 days).

 -  for rescue regimens: group A2 - high dose dual therapy (as group A1); group B2 -
 sequential therapy (as group B1); group C2 - levofloxacin-based triple therapy
 (rabeprazole 20 mg + amoxicillin 1000 mg + levofloxacin 250 mg, bid for 7 days).

 All patients will be asked to complete a questionnaire and to record symptoms and drug
 consumption daily during the treatment period. Post-treatment, the patients were seen at the
 Outpatients Clinic to investigate patient adherence and adverse effects of treatment.
Inclusion Criteria:

 -  patients having H. pylori related chronic gastritis with/without peptic ulcers who are
 aged greater than 18 years and are willing to received eradication therapy.

 Exclusion Criteria:

 -  pregnant or nursing woman

 -  serious concomitant illness and malignant tumor of any kind

 -  history of hypersensitivity to test drugs

 -  serious bleeding during the course of this ulcer

 -  previous gastric surgery

 -  receiving bismuth salts, proton pump inhibitors, or antibiotics in the previous month.