Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Abstract

Background: Susceptibility-guided therapies (SGTs) have been proposed as preferable to empirical rescue treatments after two treatment failures. The aim of this study was to perform a systematic review and meta-analysis evaluating the effectiveness and efficacy of SGT as third-line therapy. Methods: A systematic search was performed in multiple databases. Studies reporting cure rates of Helicobacter pylori with SGT in third-line therapy were selected. A qualitative analysis describing the current evidence and a pooled mean analysis summarizing the cure rates of SGT in third-line therapy was performed. Results: No randomized controlled trials or comparative studies were found. Four observational studies reported cure rates with SGT in third-line treatment, and three studies which mixed patients with second-and third-line treatment also reported cure rates with SGT. The majority of the studies included the patients when culture had been already obtained, and so the effectiveness of SGT and empirical therapy has never been compared. A pooled mean analysis including four observational studies (283 patients) showed intention-to-treat and perprotocol eradication rates with SGT of 72% (95% confidence interval 56-87%; I 2 : 92%) and 80% (95% confidence interval 71-90%; I 2 : 80%), respectively. Conclusions: SGT may be an acceptable option as rescue treatment. However, cure rates are, at best, moderate and this approach has never been compared with a well-devised empirical therapy. The evidence in favor of SGT as rescue therapy is currently insufficient to recommend its use.

Resistance patterns of refractory Helicobacter pylori infection in a referral centre in the Delaware Valley

“…In the absence of a national registry other regional centres in the United States could consider a similar review of their available data to provide comparisons across regions, in order to help facilitate antibiotic therapy for refractory HP. Routine culture has so far not been recommended, as it is not clearly beneficial over empirical rescue therapy . Even in our study, given that culture rate was approximately 70%, many patients would undergo an endoscopy without subsequent culture results, and culture is certainly an imperfect test.…”

Limited effectiveness with a 10‐day bismuth‐containing quadruple therapy (Pylera®) in third‐line recue treatment for Helicobacter pylori infection. A real‐life multicenter study

“…However, microbiologic culture is not available in many centers and is rarely undertaken in clinical practice. Additionally, a recent review revealed no clear benefit of third‐line susceptibility‐guided treatment . Collectively, these findings question the utility of culture in this context …”

Importance of antimicrobial susceptibility testing for the management of eradication inHelicobacter pyloriinfection

“…The eradication rates of susceptibility-guided treatments are generally higher than those of empirical treatment regimens[7,81,86]. Recent studies have also shown that susceptibility-based treatment improves the efficacy of the therapy used after first- or second-line treatment failure as well as the efficacy of first-line therapy (Tables 1 and 2)[26,73,82-84,87-92].…”