Researchers from Texas, USA, investigated the sources of variation of Helicobacter pylori treatment success in adults worldwide.
A total of 618 treatment groups were included in the meta-analysis.
Overall, treatment was found to be less successful with shorter treatment duration and dual drug (versus triple or quadruple drug) therapies.
For nitroimidazole-based regimens, treatment was less successful in populations with frequent childhood H. pylori infection or metronidazole resistance. These regimens were more successful in north-eastern Asia.
The team discovered that non-nitroimidazole treatment of longer duration, and those from less recent reports, were most successful.
| More effective H. pylori treatment needed where childhood infection and drug resistance are common.
| International Journal of Epidemiology |
Some 1-week regimens were highly successful in north-eastern Asia, regardless of metronidazole resistance.
These included nitroimidazole with tetracycline, bismuth, ranitidine bismuth citrate, amoxicillin, and clarithromycin, and clarithromycin with amoxicillin and proton pump inhibitor.
The most successful regimen in populations with both a high prevalence of metrondiazole resistance and frequent infection in children, was metronidazole with furazolidone and amoxicillin. However, this eliminated fewer than 70% of infections.
Lori A. Fischbach, of the School of Public Health at Dallas, University of Texas-Houston, said on behalf of fellow authors, "More effective treatments are needed for most populations of the world where H. pylori infection in children and drug resistance are common."
"Current treatment guidelines do not coincide with the best treatment regimens identified in this meta-analysis," it was concluded.