Comparison of the efficacies of triple, quadruple and sequential antibiotic therapy in eradicating Helicobacter pylori infection: A randomized controlled trial.

BACKGROUND AND AIM: There is regional variation in the eradication rates of Helicobacter pylori (H. pylori) regimens depending on the local antibiotic resistance patterns. The aim of this study was to compare the efficacies of triple, quadruple and sequential antibiotic therapy in eradicating H. pylori infection. METHODS: A total of 296 H. pylori-positive patients were randomized to receive one of the three regimens (triple, quadruple or sequential antibiotic therapy) and eradication rate was assessed by H. pylori stool antigen test. RESULTS: The eradication rates of standard triple therapy, sequential therapy and quadruple therapy were 93%, 92.9% and 96.4%, respectively (p = 0.57). CONCLUSION: Fourteen days of standard triple therapy, 14 days of bismuth-based quadruple therapy and 10 days of sequential therapy are equally efficacious in eradicating H. pylori and all regimens have optimum H. pylori eradication rates. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: CTRI/2020/04/024929.

Intractable diarrhoea due to co-infection with Cystoisospora belli and Trichuris trichiura unraveling a severely compromised host immune status.

Cystoisospora belli is an obligate intracellular coccidian parasite known to cause chronic persistent diarrhoea in immunocompromised individuals such as human immunodeficiency virus (HIV) infection, long term corticosteroid therapy, cancer chemotherapy and solid organ transplant recipients. Trichuris trichiura is a soil transmitted helminth, which predominantly causes asymptomatic or mild infections but heavy worm load can sometimes lead to chronic diarrhoea, tenesmus or rectal prolapse. We report a case of co-infection with Cystoisospora belli and Trichuris trichiura in an adult patient causing intractable diarrhea, which led to the unraveling of a severely compromised immune status in the patient enabling an appropriate therapeutic approach and further management.