Levofloxacin-based triple therapy versus bismuth-based quadruple therapy for persistent Helicobacter pylori infection:: A meta-analysis

被引:189
作者
Saad, RJ
Schoenfeld, P
Kim, HM
Chey, WD
机构
[1] Univ Michigan, Med Ctr, Taubman Ctr 3912, Physiol Lab GI,Dept Med,Div Gastroenterol, Ann Arbor, MI 48109 USA
[2] Vet Affairs Ctr Excellence Hlth Serv Res, Ann Arbor, MI USA
[3] Univ Michigan, Ctr Stat Consultat & Res, Ann Arbor, MI 48109 USA
关键词
D O I
10.1111/j.1572-0241.2006.00637.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BACKGROUND: Levofloxacin-based triple therapy has been suggested as an alternative salvage therapy to bismuth-based quadruple therapy for persistent Helicobacter pylori (H. pylori) infection. METHODS: A search of PUBMED, EMBASE, EBM Review databases and abstracts from recent Digestive Disease Week, United European Gastroenterology Week, and European Helicobacter Study Group conferences was performed. Randomized controlled trials (RCTs) comparing levofloxacin-based triple salvage therapy (levofloxacin + amoxicillin + PPI) to bismuth-based quadruple salvage therapy (bismuth + tetracycline + metronidazole + PPI) were selected for meta-analysis. Additionally, all prospective trials evaluating this levofloxacin-based triple therapy as salvage therapy were pooled to analyze optimal levofloxacin treatment duration and dosing. All selected trials confirmed prior treatment failure and post-salvage treatment eradication. RESULTS: Four RCTs compared a 10-day regimen of levofloxacin-based triple therapy to 7-day bismuth-based quadruple therapy (n = 391 patients). Levofloxacin-based triple therapy was superior to quadruple therapy (RR = 1.41 [95% CI: 1.25-1.59]). Levofloxacin-based triple therapy was better tolerated than quadruple therapy with a lower incidence of side effects (RR = 0.51 [95% CI: 0.34-0.75]) and side effects prompting discontinuation of therapy (RR = 0.30 [95% CI: 0.10-0.89]). Eleven trials (n = 547 patients) evaluating levofloxacin-based triple therapy demonstrated higher eradication rates with 10-day versus 7-day regimen (87% [95% CI: 82%-92%] vs 68% [95% CI: 62%-74%]) yet eight trials (n = 477 patients) demonstrated no difference with 500 mg daily versus 250 mg b.i.d. dosing of levofloxacin (81% [95% CI: 78%-89%] vs 84% [95% CI: 66%-97%]). CONCLUSIONS: A 10-day course levofloxacin triple therapy is more effective and better tolerated than 7-day bismuth-based quadruple therapy in the treatment of persistent H. pylori infection.
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页码:488 / 496
页数:9
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