Current role of tailored therapy in treating Helicobacter pylori infections. A systematic review, meta‐analysis and critical analysis

Abstract

Background and Aims Recent guidelines dictate that all Helicobacter pylori (H. pylori) infected subjects should receive curative therapy. The efficacy of empirical regimens for H. pylori eradication might decline with bacterial, drug, and host factors. The necessity of a tailored therapy still remains controversial. Here we provide a meta‐analysis of the current status of susceptibility‐based (tailored) therapy in which susceptibility‐based therapies were compared to the currently accepted choice of empiric therapy. In this rapidly closing era, neither the susceptibility nor empiric therapies were routinely optimized, such that we report the outcome of comparisons on the efficacy of unoptimized tailored vs. locally preferred empiric treatments. Methods PubMed, Medline, and Embase databases were searched using suitable keywords. Individual and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the fixed‐ or random‐effects model as appropriate. Heterogeneity was calculated employing the Cochrane Q test and I2 values, whereas the possibility of publication bias was examined by constructing funnel plots. Additionally, subgroup and sensitivity analyses were performed. Results Thirty‐four studies were included with a total of 9613 patients. Tailored therapy proved superior to empiric treatment [OR 2.07 (95% CI 1.53–2.79)]. However, tailored therapy achieved eradication rates >90% in only 15 (44%) studies and >95% in only 6 (17.6%). Conclusions Although tailored therapy performed better than empiric treatment, the lack of optimization of therapies failed to reliably achieve high cure rates (>90%). These results emphasize that H. pylori infection, like other infectious diseases, should utilize the principles of antimicrobial stewardship in relation to treatment guidance.

Helicobacter pylori treatment knowledge, access and barriers: A cross‐sectional study

“…54 While tailoring treatment based on local resistance is important, it must be done consider responsible antibiotic stewardship. 55,56 A belief that the treatment is worse than the symptoms of Hp would influence 70% of all our respondents' decisions to seek care and 81% indicated that knowledge about Hp being a cause of their symptoms and as a cause of GC would affect their willingness to comply with prescribed therapy.…”

“…Some previously suggested approaches include pre‐sorted pill packs, extended physician counseling, literature on known/expected side effects in easy‐to‐understand language, and careful follow up to ensure adherence 54 . While tailoring treatment based on local resistance is important, it must be done consider responsible antibiotic stewardship 55,56 …”

Equivalence Trial of the Non-Bismuth 10-Day Concomitant and 14-Day Hybrid Therapies for Helicobacter pylori Eradication in High Clarithromycin Resistance Areas

“…Empirical H. pylori therapies are the most prescribed and are still proposed as first-line options, in parallel to the antibiotic susceptibility-based therapies, by major consensus conferences [ 2 , 16 ]. Despite the fact that antibiotic stewardship is largely becoming important for H. pylori schemes, availability, cost, and convenience prevents its widespread implementation [ 2 , 31 , 32 ]. Moreover, recent meta-analyses show that most susceptibility-guided therapies fail to overcome the acceptable 90% eradication rate, or even do not perform better than the empiric quadruple (with or without bismuth) regimens [ 31 , 32 , 33 ].…”

“…Despite the fact that antibiotic stewardship is largely becoming important for H. pylori schemes, availability, cost, and convenience prevents its widespread implementation [ 2 , 31 , 32 ]. Moreover, recent meta-analyses show that most susceptibility-guided therapies fail to overcome the acceptable 90% eradication rate, or even do not perform better than the empiric quadruple (with or without bismuth) regimens [ 31 , 32 , 33 ]. When bismuth alone or in an all-in-one capsule with antibiotics is available, it is the preferred first choice for empirical therapy [ 2 ].…”

H. Pylori Treatment in the COVID-19 Era. What Have We Learned So Far?

“…The authors arbitrarily attributed their even lesser levofloxacin-based regimen eradication rates to an even more increase in levofloxacin resistance in the Egyptian community after the COVID-19 pandemic (aftermath of levofloxacin misuse in the management of COVID-19) [ 27 ]. However, one should not forget that both eradication treatments underperformed significantly compared to eradication rates of at least 90% as the desired outcome, thereby rendering their findings of low scientific value [ 31 ].…”