Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Phase IV Study Comparing the Duration of Sequential Therapy
Brief Summary: Background: Helicobacter pylori infection has been shown to be associated with the development of gastric cancer and peptic ulcer diseases. Eradication of H. pylori infection could reduce the occurence or recurrence of these diseases. However, the eradication rate of clarithromycin-based triple therapy has been declining in recent years, probably related to the increasing resistant rate to clarithromycin. It was estimated that 15-20% of patients would fail from first line standard eradication therapy and need second line rescue therapy. About 15-30% of patient would fail from second line therapy and need to be rescued with third line therapy. In recent years, the concept of sequential therapy has been advocated in the treatment of H. pylori infection. The regimen includes a PPI plus amoxicillin for five days, followed by a PPI plus clarithromycin and tinidazole for another five days. The eradication rate in the first line treatment of sequential therapy had been reported to be as high as 90%. More importantly, it has been demonstrated that the eradication rate among patients with clarithromycin-resistant strains could be as high as 89%. However, tinidazole is not available in many countries. Whether metronidazole would be an effective alternative to tinidazole in the sequential therapy remains unknown. Besides, whether extending the duration of sequential therapy from 10-day to 14-day would result in higher eradication rate also deserves further investigation. Furthermore, data on the efficacy of rescue regimens for patients who failed from first line sequential therapy are also lacking. The impact of clarithromycin, metronidazole resistance and CYP2C19 polymorphism on the sequential therapy containing metronidazole (rather than tinidazole) also has not been reported.

Aims: Therefore, we aim to assess

1. whether the substitution of metronidazole for tinidazole in the sequential therapy is also more effective than clarithromycin-based triple therapy
2. whether extending the duration of sequential therapy from 10-day to 14-day would achieve higher eradication rate
3. whether levofloxacin-based sequential therapy for 14-days is effective as second line rescue regimen for those who failed from first line sequential therapy
4. the impact of antibiotic resistance and CYP2C19 polymorphism on the eradication rate of sequential therapy


Options:
A: Arm Label: 7-day quadruple therapy; Type: EXPERIMENTAL; Interventions: Drug: 7-day quadruple therapy | Arm Label: 10-day sequential therapy; Type: EXPERIMENTAL; Interventions: Drug: 10-day sequential therapy | Arm Label: 7-day standard triple therapy; Type: ACTIVE_COMPARATOR; Interventions: Drug: 7-day standard triple therapy | Intervention Type: DRUG; Name: 7-day quadruple therapy; Assigned to Arm(s): 7-day quadruple therapy | Intervention Type: DRUG; Name: 10-day sequential therapy; Assigned to Arm(s): 10-day sequential therapy | Intervention Type: DRUG; Name: 7-day standard triple therapy; Assigned to Arm(s): 7-day standard triple therapy
B: Arm Label: triple therapy; Type: ACTIVE_COMPARATOR; Interventions: Drug: 10 day triple therapy | Arm Label: Concomitant therapy; Type: ACTIVE_COMPARATOR; Interventions: Drug: 10 day sequential therapy | Arm Label: sequential therapy; Type: ACTIVE_COMPARATOR; Interventions: Drug: 10 day concomitant therapy | Intervention Type: DRUG; Name: 10 day triple therapy; Assigned to Arm(s): triple therapy | Intervention Type: DRUG; Name: 10 day sequential therapy; Assigned to Arm(s): Concomitant therapy | Intervention Type: DRUG; Name: 10 day concomitant therapy; Assigned to Arm(s): sequential therapy
C: Arm Label: Group A; Type: EXPERIMENTAL; Interventions: Drug: Sequential therapy for 14 days | Arm Label: Group B: Sequential therapy for 10 days; Type: EXPERIMENTAL; Interventions: Drug: Sequential therapy for 10 days | Arm Label: Group C: Triple therapy for 14 days; Type: ACTIVE_COMPARATOR; Interventions: Drug: Triple therapy for 14 days | Intervention Type: DRUG; Name: Sequential therapy for 14 days; Assigned to Arm(s): Group A | Intervention Type: DRUG; Name: Sequential therapy for 10 days; Assigned to Arm(s): Group B: Sequential therapy for 10 days | Intervention Type: DRUG; Name: Triple therapy for 14 days; Assigned to Arm(s): Group C: Triple therapy for 14 days
D: Arm Label: AOC group; Type: EXPERIMENTAL; Interventions: Drug: amoxicillin, clarithromycin, metronidazole, rabeprazole | Arm Label: AOM group; Type: EXPERIMENTAL; Interventions: Drug: amoxicillin, clarithromycin, metronidazole, rabeprazole | Arm Label: Sequential group; Type: EXPERIMENTAL; Interventions: Drug: amoxicillin, clarithromycin, metronidazole, rabeprazole | Arm Label: concomitant group; Type: EXPERIMENTAL; Interventions: Drug: amoxicillin, clarithromycin, metronidazole, rabeprazole | Intervention Type: DRUG; Name: amoxicillin, clarithromycin, metronidazole, rabeprazole; Assigned to Arm(s): AOC group, AOM group, Sequential group, concomitant group

Answer: C