Dr Yee Hui Yeo and colleagues from Taiwan determined the optimal regimen of different first-line Helicobacter pylori eradication therapies according to the clarithromycin resistance rate.
The research team performed an electronic search for articles published between 2005 and 2016.
Randomized, controlled trials that reported the effectiveness of first-line eradication therapies in treatment-naïve adults were included.
There were 2 independent reviewers that performed articles screening and data extraction.
Network and traditional meta-analyses were conducted using the random effect model.
|There were 117 trials for 17 Helicobacter pylori eradication regimens that were eligible for inclusion|
Subgroup analyses were performed to determine the ranking of regimens in countries with high (>15%) and low (<15%) clarithromycin resistance.
Data including adverse events and therapeutic cure rate were also extracted and analyzed.
The researchers identified 117 trials for 17 Helicobacter pylori eradication regimens that were eligible for inclusion.
Compared with 7-day clarithromycin-based triple therapy, sequential therapy for 14 days had the highest effectiveness.
Sequential therapy for 14 days and hybrid therapy for 10 days or more represented the most effective regimen in areas with high and low clarithromycin resistance, respectively.
The research team found that the effectiveness of standard triple therapy was below therapeutic eradication rate in most of the countries.
Longer duration was associated with higher eradication rate, but with a higher risk of events that lead to discontinuation.
Dr Shiu's team concludes, "Sequential therapy for 14 days and hybrid therapy appeared to be the most effective therapies in countries with high and low clarithromycin resistance, respectively."
"The clinical decision for optimal regimen can be supported by referring to the rank ordering of relative efficacies stratified by local eradication rates, antibiotic resistance and safety profile."