Moxifloxacin-Containing Triple Therapy versus Bismuth-Containing Quadruple Therapy for Second-Line Treatment of Helicobacter pylori Infection: A Meta-Analysis

Background: Moxifloxacin-containing triple therapy has been suggested as an alternative second-line therapy for Helicobacter pylori infection. Aims: To systematically review the efficacy and tolerance of moxifloxacin-containing triple therapy in second-line H. pylori eradication, and to conduct a meta-analysis of studies comparing this regimen with bismuth-containing quadruple therapy. Materials and Methods: Electronic databases including Medline, Embase, Cochrane controlled trials register, Web of Science, PubMed, Chinese Biomedical Literature Database (updated to December 2010), and manual searches were conducted. A meta-analysis of all randomized controlled trials (RCTs) comparing moxifloxacin-containing triple therapy to bismuth-containing quadruple therapy in the second-line treatment of H. pylori infection was performed. Results: Seven RCTs including 787 patients were assessed. The meta-analysis showed that the eradication rate in the moxifloxacin group was significantly higher than that in the quadruple therapy group (74.9 vs 61.4%, OR 1.89, 95% CI: 1.38-2.58, p < .0001); besides, the rates of side effects and discontinuing therapy because of side effects in the moxifloxacin group were significantly lower than those in the quadruple therapy group (side effects: 10.1 vs 27.8%, OR 0.27, 95% CI: 0.18-0.41, p < .00001; discontinuing therapy because of side effects: 1.4 vs 8.2%, OR 0.18, 95% CI: 0.08-0.40, p < .0001). These results were constant in the sensitivity analyses. Conclusion: Moxifloxacin-containing triple regimen is more effective and better tolerated than the bismuth-containing quadruple therapy in the second-line treatment of H. pylori infection.