Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: A Randomized Controlled Trial of Triple Therapy Versus Sequential Therapy Versus Concomitant Therapy as First Line Treatment for Helicobacter Pylori Infection
Brief Summary: Triple therapy (TT) comprising proton pump inhibitor (PPI), amoxicillin 1g and clarithromycin 500mg twice daily has long been considered one of the standard treatment for H. pylori infection as initial studies demonstrated success rates of \> 90% on per protocol analysis (PP) and \> 80% on intention to treat (ITT) analysis. However increasing bacterial resistance, especially to clarithromycin, has been reported and there are concerns that the efficacy of TT has decreased. Sequential therapy (ST) is an alternative first line therapy that consists of 5 days of treatment with a PPI and amoxicillin followed by 5-day treatment with the PPI and clarithromycin and metronidazole. The rationale for this approach is that amoxicillin may weaken the bacterial cell wall in the initial phase of treatment, and prevent the development of drug efflux channels that inhibit clarithromycin from binding to ribosomes and thus help to improve the efficacy of clarithromycin in the second phase of treatment. A recent meta-analysis based on mainly European studies showed that the success rate of ST compared to TT was 92.8 - 96% vs. 76.2 - 78.8%. Concomitant therapy (CT) is another alternative first line treatment that consists of 10 days of PPI, amoxicillin, clarithromycin and metronidazole. The rationale for using CT as a first line treatment option is to address the possibility of clarithromycin resistance which is increasingly encountered in clinical practice. Currently there are no randomized controlled studies that compared TT with ST in Singapore, although both regimens are being used in routine clinical practice. The hypothesis is that ST is superior to TT as first line treatment for H. pylori infection.

The study aim to compare 10-day TT versus 10-day ST versus 10-day CT as first line treatment for H. pylori infection in Singapore.


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: 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
C: Intervention Type: DRUG; Name: Placebo amoxicillin pantoprazole clarithromycin tinidazole; Assigned to Arm(s): N/A
D: 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

Answer: D