# Efficacy of Concomitant Therapy Versus Triple Therapy in Eradicating Helicobacter pylori Infection: A Retrospective Study

## TL;DR

This study found that concomitant therapy is more effective than triple therapy for eradicating Helicobacter pylori infection in Pakistan.

## Contribution

The study compares the efficacy of concomitant therapy versus triple therapy for H. pylori in a resource-limited setting.

## Key findings

- Concomitant therapy had a 91.90% eradication rate compared to 72.29% for triple therapy.
- Age and symptom duration were significant predictors of success in the concomitant therapy group.
- Concomitant therapy may be a better option in areas with high antibiotic resistance.

## Abstract

Background

Helicobacter pyloriis a widespread bacterial infection that is often linked to significant health and economic burdens in affected populations. The rise of antibiotic resistance has reduced the effectiveness of standard triple therapy (TT), highlighting the need for alternative treatment strategies, especially in resource-constrained countries like Pakistan, where comparative research on different H. pylori treatment regimens remains limited. This study aims to compare the efficacy of concomitant therapy (CT) versus TT in the eradication of H. pylori infection.

Methods

This retrospective study was conducted over a 12-month period (July 2021 to July 2022) in the medicine and gastroenterology departments of Jinnah Hospital, Lahore, Pakistan. A total of 296 patients diagnosed with H. pylori infection via the urea breath test were enrolled using consecutive sampling, following predefined inclusion and exclusion criteria. Patients were divided into two groups of 148 each: Group A received CT (esomeprazole, amoxicillin, clarithromycin, and metronidazole), and Group B received standard TT (esomeprazole, amoxicillin, and clarithromycin). Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, NY, USA), applying independent samples t-tests, chi-square tests, and logistic regression analysis. A p-value of less than 0.05 was considered statistically significant.

Results

Among the 296 patients, the overall H. pylori eradication rate was 82.09%. The eradication rate was significantly higher in the CT group (91.90%) compared to the TT group (72.29%) (p = 0.008). In the CT group, age (OR: 1.57; 95% CI: 1.25-1.98; p = 0.03) and duration of symptoms (OR: 1.42; 95% CI: 1.10-1.77; p = 0.02) were significant predictors of successful eradication, while gender (OR: 1.10; 95% CI: 1.01-1.32; p = 0.06) was not. In the TT group, age (OR: 1.22; 95% CI: 1.05-1.51; p = 0.06), gender (OR: 1.01; 95% CI: 0.71-1.47; p = 0.07), and duration of symptoms (OR: 1.26; 95% CI: 1.17-1.60; p = 0.09) were not significant predictors of eradication.

Conclusions

This study suggests that CT is more effective than TT in eradicating H. pylori infection. In the CT group, being younger than 45 years and having symptoms for less than six months were significant predictors of treatment success. These findings provide valuable insights into optimal treatment strategies for H. pylori in resource-limited settings and emphasize the need for further research to establish effective eradication protocols.