Comparison of Treatments for H. pylori Infection

August 26, 2015

Comparison of Treatments for H. pylori Infection

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

In a comprehensive meta-analysis, several treatment regimens were superior to standard 7-day triple therapy for Helicobacter pylori eradication.

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

As antibiotic resistance of Helicobacter pylori increases, eradication rates with standard therapy decrease. Among the many alternative therapies that have been studied, which are the most effective?

To explore this question, researchers in China performed a systematic review and network meta-analysis. Their study, which involved 143 randomized, controlled trials selected from among 15,565 identified in the literature, covered 14 types of treatment for H. pylori infection.

Standard triple therapy (a proton-pump inhibitor [PPI] with clarithromycin plus either amoxicillin or metronidazole) for 7 days had the lowest eradication rates (73%; 95% confidence interval, 0.71%–0.75%). The highest rates were achieved with 10 or 14 days of concomitant treatment (a PPI plus 3 antibiotics — often amoxicillin, clarithromycin, and 5-nitroimidazole), 10 or 14 days of probiotic-supplemented triple therapy, 10 or 14 days of levofloxacin-based triple therapy, 14 days of hybrid treatment, and 10 or 14 days of sequential treatment. Generally, longer treatments were associated with higher eradication rates, albeit also with greater likelihood of adverse events. The meta-analysis had moderate heterogeneity, but sensitivity analyses did not change the outcomes. Not all treatments could be compared with each other because of the paucity or absence of head-to-head studies.

Comment

This comprehensive meta-analysis provides information on the comparative effectiveness of different treatments for H. pylori infection. Several factors could have influenced the results. This analysis probably deals primarily with first infections, not recurrences. Although treatments were divided into 14 types, dosing, specific antibiotics, and administration varied within the types. Some comparisons had very few (or no) studies, suggesting some of the head-to-head analyses were underpowered. Finally, the authors noted that antibiotic resistance — which was not measured in the studies — varies greatly by region, so the findings are more relevant to areas contributing large numbers of studies to the analysis.

Editor Disclosures at Time of Publication

  • Disclosures for David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) at time of publication Leadership positions in professional societies World Gastroenterology Organization (Treasurer)

Citation(s):

Reader Comments (3)

CARLOS ALBERTO ASTUDILLO ESPINOSA Physician, Cardiology, CARDIOIMAGENES DEL CAUCA

ES UNA REVISTA MUY INTERESANTE CON UN NIVEL MUNDIAL MAXIMO EN EL TRATAMIENTO DE LOS TEMAS QUE SIGAN ASI FELICITACIOES.

HAMED ALKAFF Physician, Gastroenterology, Sana'a University Hospital, Sana'a, Yemen

Detailed further studies are recommended by using variants of probiotics for prolonged period to eradicate H. pylori !.

Jorge Vergara Physician, Infectious Disease, Hospital Nacional

Valioso aporte con nuevos métodos antibióticos tratando de alcanzar eliminación completa del H.pylori. Necesidad pendiente de como poder llegar a evitar una nueva colonización bacteriana
gastrointestinal.

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.