Doxycycline in Eradication Therapy of <b><i>Helicobacter pylori</i></b> - A Systematic Review and Meta-Analysis

Abstract

Background: Since resistance of Helicobacter pylori is developing very fast all over the world, new treatment regimens for eradication are urgently needed. Aim: To compare eradication success rate of H. pylori treatment regimens with and without doxycycline. Methods: English medical literature searches were conducted for regimens including doxycycline for eradication of H. pylori. Searches were performed up to August 31, 2015, using MEDLINE, PubMed, EMBASE, Scopus and CENTRAL. Meta-analysis was performed by using comprehensive meta-analysis software. Pooled ORs and 95% CIs were calculated comparing treatment regimens for eradication of H. pylori infection with and without doxycycline. Results: The OR for eradication success rate in a fixed model was in favor for treatment regimens with doxycycline: 1.292, 95% CI 1.048-1.594, p = 0.016. There was no significant heterogeneity in the included studies: Q = 15.130, d.f. (Q) = 8, I² = 47.126, p > 0.10. When treatment regimens with doxycycline were compared only with treatment regimens with tetracycline, no significant difference was found in eradication success rate: OR 0.95, 95% CI 0.68-1.32, p = 0.77. But when treatment regimens with doxycycline were compared with treatment regimens without tetracycline, the OR in favor of doxycycline was even higher: OR 1.59, 95% CI 1.21-2.09, p < 0.001. Conclusion: In this meta-analysis, we confirmed doxycycline efficiency in the eradication of H. pylori. Thus, triple, quadruple or even high dose dual therapy with regimens containing doxycycline should be considered.

Correlation of registered drug packs with Maastricht V/Florence Consensus Report and national treatment guidelines for management of Helicobacter pylori infection

“…Furthermore, tetracycline hydrochloride is not registered in Croatia and Slovenia; hence, it was replaced with doxycycline. Successful treatment regimens of H pylori with doxycycline have been previously described in the literature . For quadruple bismuth therapies, bismuth oxide was considered in Croatia and Slovenia (instead of other forms, ie bismuth subsalicylate) as H pylori indication was identified in Summary of product characteristics for bismuth oxide…”

“…Successful treatment regimens of H pylori with doxycycline have been previously described in the literature. 26 For quadruple bismuth therapies, bismuth oxide was considered in Croatia and Slovenia (instead of other forms, ie bismuth subsalicylate) as H pylori indication was identified in Summary of product characteristics for bismuth oxide. 27 Active substance, dose strength and proposed treatment duration for all drugs listed in considered guidelines, and all treatment lines, were considered in the study.…”

Helicobacter pylori infection: A recent approach to diagnosis and management

“…However, further large randomized controlled trials are needed to evaluate the efficacy of this regimen [69]. A meta-analysis showed treatment compared with doxycycline and tetracycline only, and there was no difference in eradication rates; however, compared with other regimens, there were higher eradication rates with doxycycline [70].…”

Treatment of Helicobacter pylori infection 2016

“…The same group looked at bismuth when given as part of a quadruple regimen with rifabutin in patients who had failed two previous eradication regimens and found excellent eradication rates of 96.6% . Support for the use of doxycycline in H. pylori eradication regimens was found in a meta‐analysis carried out this year which showed a pooled OR for eradication success rate of 1.292 . Another study looked at rabeprazole, minocycline, bismuth, and amoxicillin as both first‐ and second‐line treatment, finding eradication rates of 87.5% and 82.9%, respectively .…”

“…50 Support for the use of doxycycline in H. pylori eradication regimens was found in a meta-analysis carried out this year which showed a pooled OR for eradication success rate of 1.292. 51 Another study looked at rabeprazole, minocycline, bismuth, and amoxicillin as both first-and second-line treatment, finding eradication rates of 87.5% and 82.9%, respectively. 52 The anti-H. pylori mechanism of bismuth is not fully understood, but one mechanistic study carried out this year suggests it works by impeding proton entry into the bacteria, leading to a decrease in the expected fall in cytoplasmic pH.…”