Novel Information Regarding the Treatment of Helicobacter pylori Infection: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Abstract

Objective: Helicobacter pylori infects at least 50% of the world’s human population. The current study aimed to assess and compare the efficacy of triple versus quadruple therapy. Methods: Randomized clinical trials (RCTs) consisting of triple and quadruple therapy were identified through electronic and manual searches in the national and international online databases (IsI, Magiran, Embase, PubMed, and Scopus). The random-effects model was applied to pool analysis. Funnel plots and the Egger test were used to examine publication bias. Results: After a detailed review of the selected articles, 79 RCTs were included in the meta-analysis; it was based on using triple and quadruple therapy as the first and second-line treatment. The results showed that quadruple therapy in the first-line treatment had a higher eradication rate than triple therapy. Overall, the eradication rate with triple therapy was 74% (95% CI, 71%-77%) for intention-to-treat (ITT) analysis and 80% (95% CI, 77%-82%) for per-protocol (PP) analysis. Generally, the eradication rate with quadruple therapy was 82% (95% CI, 78.0%-86.0%) for ITT analysis and 85% (95% CI, 82.0%-89.0%) for PP analysis. The analysis also revealed that quadruple therapy was more effective for 7 or 10 days. Conclusion: The current study results demonstrated that quadruple therapy has better effectiveness than triple therapy as the first-line treatment; however, in the second-line treatment, the effectiveness of quadruple and triple regimens is almost similar. The effectiveness of quadruple therapy in the Asian population was found to be slightly higher than that of triple therapy, while this difference was considerably higher in the European population.

Antiurease Activity of Antibiotics: In Vitro, In Silico, Structure Activity Relationship, and MD Simulations of Cephalosporins and Fluoroquinolones

“…3 A recent systematic and metaanalysis of clinical trial review has demonstrated that the quadruple therapy was found to be more effective (82% eradication rate) than triple therapy (74% eradication rate) as the first line treatment, but little differences were noticed when quadruple therapy was used in the second-line treatment, taking into consideration the other relevant risk factors (Table 1). 4 Recently, different types of probiotics have been reported for reducing the side effects of adjuvant anti-HP therapy and increasing the HP eradication rates in various combinations and at different doses and durations. Limosilactobacillus reuteri has been found to be an effective probiotic for HP treatment.…”