to compare the efficacy of the high dose amoxicillin and pantoprazole dual therapy for Helicobacter Pylori (HP) eradication in comparison with clarithromycin base quadruple regimen

The present study designed as a double blind, randomized controlled trial (RCT) on patients with confirmed HP infection referring to eight medical centers in three countries of Iran, Egypt, and Vietnam during October 2021 to March 2022. After obtaining written consent, the participants randomly divided into two groups to receive either high dose amoxicillin and pantoprazole dual therapy (group A) or clarithromycin base quadruple regimen (group B) for 2 weeks and followed by 4 weeks of therapy with pantoprazole. Then the rate of HP eradication in each group determined and compared

Finally, 619 patients with confirmed HP infection included and randomly divided into two groups. Eradication rates in groups A and B were 68.3% and 85.6%, respectively, based on intention-to-treat (ITT) analysis, and 72.2% and 89.8% according to per-protocol (PP) analysis (P<0.0001). Group A had a lower rate of adverse events than group B (22.0% vs. 40.1%, P< 0.0001). There was no significant difference between the complete compliance rate among groups A and B (90.7 % vs. 89.0% respectively, P= 0.718).

the results of current study shows that for treating HP infection, high-dose amoxicillin-PPI dual therapy failed to achieve high eradication rates compared with a clarithromycin-based quadruple regimen. Clarithromycin-based quadruple therapy for H. pylori eradication has a higher eradication rate despite more side effects, and similar compliance compared to high-dose dual therapy.