Background:  For eradication of Helicobacter pylori in antral gastritis, the conventional triple drug therapy comprising of amoxicillin, clarithromycin, and a proton pump inhibitor (PPI) is the most widely used first line therapy. A novel first line regimen the sequential therapy comprising of amoxicillin followed by clarithromycin and a nitroimidazole (tinidazole or metronidazole) along with a PPI was shown to have higher eradication rates and was projected as a viable alternative to failing triple drug therapy. 

Aim: To compare the efficacy and side effect profile of sequential and triple drug therapy in eradication of H pylori infection in Indian population. 

Methods: A randomized controlled trial (RCT) was conducted in a tertiary care centre of North India. A total of 350 patients with rapid urease test (RUT) positive antral gastritis were randomized in the ratio of 1:1 to receive either 10 days of sequential or 14 days of triple drug therapy. Successful eradication was defined as RUT negativity by repeat endoscopy done 04 weeks after treatment completion. Side effect profile was assessed by patient interview at the time of repeat endoscopy. 

Results: The eradication rates were 93.14 % (163/175) and 91.4 % (160/175) in sequential and triple drug therapy group respectively which were similar (p-value 0.547). In terms of side effect profile, there was no significant difference between the two regimens. 

Conclusion: Both the 10 day sequential and 14-day triple drug therapies are equally efficacious in eradication of H pylori in Indian population with similar side effect profile.