Should Metronidazole Be Included in Second-Line Treatment After Standard Triple Therapy for Helicobacter pylori?: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

被引:0
作者
Mori, Hideki [1 ]
Nishizawa, Toshihiro [2 ]
Morioka, Kohei [1 ,3 ]
Kato, Motohiko [3 ]
Kanai, Takanori [1 ]
机构
[1] Keio Univ, Sch Med, Dept Internal Med, Div Gastroenterol & Hepatol, Tokyo, Japan
[2] Int Univ Hlth & Welf, Narita Hosp, Dept Gastroenterol & Hepatol, Narita, Japan
[3] Keio Univ, Sch Med, Ctr Diagnost & Therapeut Endoscopy, Tokyo, Japan
关键词
bismuth quadruple therapy; eradication failure; metronidazole; rescue therapy; second-line therapy; RANITIDINE BISMUTH CITRATE; 2 RESCUE THERAPIES; QUADRUPLE THERAPY; ANTIBIOTIC-RESISTANCE; DUAL THERAPY; AMOXICILLIN-METRONIDAZOLE; ERADICATION THERAPY; INFECTION; FAILURE; EFFICACY;
D O I
10.1111/hel.70010
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and AimAlthough standard triple therapy remains the first-line eradication treatment for H. pylori worldwide, it is unclear whether metronidazole should be included empirically in second-line eradication treatments. The aim of this study was to compare the efficacy of metronidazole-containing regimens with that of metronidazole-free regimens after failure of first-line eradication using standard triple therapy.MethodsPubMed, the Cochrane Library, and the Igaku-Chuo-Zasshi database were searched to identify RCTs eligible for inclusion in this systematic review and meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.ResultsThirteen eligible RCTs were included, with a total of 2039 patients assigned to metronidazole-containing (975 patients) or metronidazole-free (1064 patients) regimens. Metronidazole-containing regimens had significantly lower eradication failure rates than regimens without metronidazole (OR 0.55; 95% CI, 0.39-0.78). Subgroup analysis based on the regional risk of metronidazole resistance demonstrated that metronidazole-containing regimens had lower eradication failure rates not only in low-risk regions but also in high-risk regions (OR, 0.29; 95% CI, 0.11-0.74 and OR, 0.66; 95% CI, 0.49-0.91, respectively).ConclusionAfter failure of standard triple therapy, secondary eradication treatment regimens containing metronidazole demonstrate higher eradication rates than those without metronidazole.
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页数:12
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