Currently there is no ideal first or second-line treatment for achieving 100% eradication. The therapeutic order should be carried out according to the initial treatment and local antimicrobial resistance studies.

Background: The success rates of therapies for treating Helicobacter pylori vary greatly worldwide and the ideal treatment has yet to be clearly established. Aims: A systematic review was carried out to evaluate the effectiveness of current first and second-line therapies in treating H. pylori infection. Methods: Two researchers independently carried out Internet search engine reviews (PUBMED, EMBASE, MEDLINE) of clinical trials on adults published between 1990 and 2012 in both English and Spanish. Results: Forty-three (n = 8,123) clinical trials were evaluated that included first and second-line triple, quadruple, and sequential therapies. The eradication rates of the standard triple therapy are unacceptable (≤ 80%) in countries where H. pylori is highly resistant to clarithromycin and metronidazole. Administration of the standard triple therapy for more than 7 days does not improve its effectiveness. No statistically significant differences were observed between the eradication rates of the quadruple therapy with bismuth and the standard triple therapy. Even though the sequential and concomitant therapies are equally successful regimens, the triple therapy with levofloxacin offers the best results as first and second-line treatment, but quinolone resistance can diminish its effectiveness. The triple therapy with levofloxacin and the sequential and concomitant treatments were superior to the standard triple regimen as first-line therapy. Conclusions: Currently there is no ideal first or second-line treatment for achieving 100% eradication. The therapeutic order should be carried out according to the initial treatment and local antimicrobial resistance studies. Tratamiento ideal del Helicobacter pylori: una revisión sistemática ResumenAntecedentes: Las tasas de éxito de las terapias para tratar el Helicobacter pylori varían ampliamente a nivel mundial. El tratamiento óptimo no ha sido claramente establecido. Objetivo: Se realizó un revisión sistemática para evaluar la eficacia de las terapias actuales de primera y segunda línea en la infección por Helicobacter pylori. Métodos: Dos investigadores realizaron la revisión independiente en motores de búsqueda electrónica (PUBMED, EMBASE, MEDLINE) de ensayos clínicos publicados entre 1990 y 2012, incluyendo adultos e idiomas inglés y español. Resultados: Se evaluaron 43 ensayos clínicos (n = 8,123), que incluyen terapias triples, cuádruples y secuenciales, de primera y segunda línea. Las tasas de erradicación de la terapia triple estándar son inaceptables (≤ 80%) en países donde el H. pylori presenta alta resistencia a claritromicina y metronidazol. Un tiempo mayor a 7 días no mejora la eficacia de la triple terapia estándar. No se observaron diferencias significativas entre las tasas de erradicación de la terapia cuádruple con bismuto y la triple terapia estándar. Aunque las terapias secuencial y concomitante son regímenes igualmente exitosos, la terapia triple con levofloxacino ofrece los mejores resultados como primera y segunda línea, pero la resistencia a quinolon...

Summary Background Success in H. pylori eradication with conventional therapies has decreased to unacceptable levels (≤80%). New schemes of combined treatment are currently needed. Aim To test a miscellaneous therapy for H. pylori eradication. Methods/patients Open‐label, pilot, single‐centre and prospective study. Patients received a 15‐day treatment scheme that consisted of 5 initial days of lansoprazole 30 mg b.d., amoxicillin 1 g b.d., and metronidazole 500 mg t.d.s.; days 6 to 10: lansoprazole 30 mg q.d.s. and metronidazole 500 mg t.d.s.; days 11 to 15: lansoprazole 30 mg b.d., clarithromycin 500 mg b.d. and metronidazole 500 mg t.d.s. Each patient underwent an upper endoscopy before treatment and a second follow‐up endoscopy at least 4 weeks after therapy. Success was defined on the basis of an eradication rate following a per‐protocol analysis ≥95%. Biopsies before and after therapy were obtained for histological evaluation and rapid urease test. Results One hundred and twenty‐two patients were enrolled and 118 patients completed the study. The eradication rate for H. pylori with miscellaneous therapy was 94% (confidence Interval (CI) 95%, 90–98.3%) in the per‐protocol analysis (PP) and 91% (95% CI, 86–96%) in the intention‐to‐treat (ITT) analysis. Adherence to treatment was 96% (113 patients). Among patients who completed treatment, 55% presented adverse events, mainly nausea and abdominal pain. Conclusion A miscellaneous therapy, based on the combination of multiple medications in high doses for 2 weeks, and with gastric pH elevation, is a highly effective treatment as a first‐line therapy for the eradication of H. pylori.