Meta-Analysis of Bismuth Quadruple Therapy versus Clarithromycin Triple Therapy for Empiric Primary Treatment of Helicobacter pylori Infection

被引:107
作者
Venerito, Marino [1 ]
Krieger, Tina [2 ]
Ecker, Thomas [2 ]
Leandro, Gioacchino [3 ]
Malfertheiner, Peter [1 ]
机构
[1] Otto Von Guericke Univ, Dept Gastroenterol Hepatol & Infect Dis, DE-39120 Magdeburg, Germany
[2] Ecker Ecker GmbH, Hamburg, Germany
[3] S De Bellis IRCCS, Gastroenterol Hosp, Gastroenterol Unit 1, Castellana Grotte, Italy
关键词
Helicobacter pylori; Quadruple therapy; Triple therapy; Antibiotic resistance; ANTIBIOTIC-RESISTANCE; RANDOMIZED-TRIAL; DUODENAL-ULCER; IN-VITRO; ERADICATION; EFFICACY; OMEPRAZOLE; MANAGEMENT; TETRACYCLINE; MULTICENTER;
D O I
10.1159/000350719
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: In areas with high clarithromycin resistance, bismuth quadruple therapy (BQT) is recommended instead of clarithromycin triple therapy (CTT) as the first-line treatment for Helicobacter pylori eradication. Methods: Randomized clinical trials (RCTs) comparing BQT to CTT were identified through electronic and manual searches. A meta-analysis was performed to compare the efficacy and tolerability of these two regimens as first-line treatments for H. pylori infection. The effect of antibiotic resistance on treatment efficacy was also analyzed. Results: Twelve RCTs were included. BQT achieved eradication in 77.6% of patients, whereas CTT achieved an eradication rate of 68.9% [risk difference (RD) = 0.06, 95% CI: -0.01/0.13]. A high heterogeneity among the trials was found (X-2 = 50.16, p < 0.00001; I-2 = 78%). In the subgroup analysis for treatment duration, the 10-day BQT was more effective than the 7-day CTT (RD = 0.25, 95% CI: 0.18/0.32), whereas no differences were observed between CTT and BQT given for 7 or 10 days. There were no statistical differences in side effects and compliance between both therapies (RD = 0.92, 95% CI: 0.76/1.12, and RD = -0.03, 95% CI: -0.05/0.00, respectively). The effect of antibiotic resistance on eradication rates was reported in 4 of the 12 RCTs. Clarithromycin resistance significantly affected the efficacy of CTT (RD = 0.75, 95% CI: 0.63/0.87), whereas BQT efficacy was not affected by metronidazole resistance (RD = 0.09, 95% CI: -0.06/0.25). Conclusions: The 10-day BQT was more effective than the 7-day CTT as a first-line therapy for H. pylori infection, whereas BQT and CTT for 7 or 10 days yielded similar eradication rates. Compliance and side effect rates were similar for both therapies. BQT overcomes clarithromycin resistance and its efficacy is not affected by metronidazole resistance. Copyright (c) 2013 S. Karger AG, Basel
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页码:33 / 45
页数:13
相关论文
共 34 条
[1]  
[Anonymous], HDB UNDERSTANDING PR
[2]   Guidelines for the Management of Helicobacter pylori Infection in Japan: 2009 Revised Edition [J].
Asaka, Masahiro ;
Kato, Mototsugu ;
Takahashi, Shin-ichi ;
Fukuda, Yoshihiro ;
Sugiyama, Toshiro ;
Ota, Hiroyoshi ;
Uemura, Naomi ;
Murakami, Kazunari ;
Satoh, Kiichi ;
Sugano, Kentaro .
HELICOBACTER, 2010, 15 (01) :1-20
[3]   One-week triple vs. quadruple therapy for Helicobacter pylori infection -: a randomized trial [J].
Calvet, X ;
Ducons, J ;
Guardiola, J ;
Tito, L ;
Andreu, V ;
Bory, F ;
Guirao, R .
ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 2002, 16 (07) :1261-1267
[4]   American college of gastroenterology guideline on the management of Helicobacter pylori infection [J].
Chey, William D. ;
Wong, Benjamin C. Y. .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2007, 102 (08) :1808-1825
[5]   Treatment of Helicobacter pylori in surgical practice:: A randomised trial of triple versus quadruple therapy in a rural district general hospital [J].
Ching, Siok Siong ;
Sabanathan, Sivakumaran ;
Jenkinson, Lloyd R. .
WORLD JOURNAL OF GASTROENTEROLOGY, 2008, 14 (24) :3855-3860
[6]   Resistance of Helicobacter pylori strains to antibiotics in Korea with a focus on fluoroquinolone resistance [J].
Chung, Jun-Won ;
Lee, Gin Hyug ;
Jeong, Jin-Yong ;
Lee, Sun Mi ;
Jung, Ji Hoon ;
Choi, Kee Don ;
Song, Ho June ;
Jung, Hwoon-Yong ;
Kim, Jin-Ho .
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2012, 27 (03) :493-497
[7]  
de Boer WA, 1999, EUR J GASTROEN HEPAT, V11, P697
[8]   Second Asia-Pacific Consensus Guidelines for Helicobacter pylori infection [J].
Fock, K. Ming ;
Katelaris, Peter ;
Sugano, Kentaro ;
Ang, Tiing Leong ;
Hunt, Richard ;
Talley, Nicholas J. ;
Lam, Shiu Kum ;
Xiao, Shu-Dong ;
Tan, Huck Joo ;
Wu, Chun-Ying ;
Jung, Hyun Chae ;
Bui Huu Hoang ;
Kachintorn, Udom ;
Goh, Khean-Lee ;
Chiba, Tsutomu ;
Rani, Abdul Aziz .
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2009, 24 (10) :1587-1600
[9]   Meta-analysis:: duration of first-line proton-pump inhibitor-based triple therapy for Helicobacter pylori eradication [J].
Fuccio, Lorenzo ;
Minardi, Maria Eugenia ;
Zagari, Rocco Maurizio ;
Grilli, Diego ;
Magrini, Nicola ;
Bazzoli, Franco .
ANNALS OF INTERNAL MEDICINE, 2007, 147 (08) :553-562
[10]   Triple vs. quadruple therapy for treating Helicobacter pylori infection:: a meta-analysis [J].
Gené, E ;
Calvet, X ;
Azagra, R ;
Gisbert, JP .
ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 2003, 17 (09) :1137-1143