TY - JOUR
T1 - Systematic review and meta-analysis: Susceptibility-guided versus empirical antibiotic treatment for Helicobacter pylori infection
AU - López-Góngora, Sheila
AU - Puig, Ignasi
AU - Calvet, Xavier
AU - Villoria, Albert
AU - Baylina, Mireia
AU - Muñoz, Neus
AU - Sanchez-Delgado, Jordi
AU - Suarez, David
AU - García-Hernando, Victor
AU - Gisbert, Javier P.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - © The Author 2015. Background: The cure rate of standard triple therapy for Helicobacter pylori infection is unacceptably low. Susceptibility-guided therapies (SGTs) have been proposed as an alternative to standard empirical treatments. The aim of this study was to perform a systematic review and meta-analysis evaluating the efficacy of SGTs. Methods: A systematic search was performed in multiple databases. Randomized controlled trials comparing cure rates of SGTs versus those of empirical therapy were selected and analysed separately for first- and second-line treatments. A meta-analysis was performed using risk ratio (RR) and number needed to treat (NNT) to measure the effect. Results: Twelve studies were included in the meta-analysis. In first-line treatment, SGTwas more efficacious than empirical 7-10 day triple therapy (RR 1.16, 95% CI 1.10-1.23, I2 = 33%; NNT = 8). Most studies used a 7-10 day triple therapy and randomized the patients after endoscopy and/or culture, thus precluding the comparison of SGT versus non-invasive testing and empirical treatment in clinical practice. For second-line therapy, only four studies were found. Results were highly heterogeneous and no significant differences were found (RR 1.11, 95% CI 0.82-1.51, I2 = 87%). Conclusions: Once endoscopy and culture have been performed, SGT is superior to empirical 7 or 10 day triple therapy for first-line treatment. Further studies are needed to evaluate the effectiveness of SGT in clinical practice, especially when compared with currently recommended first-line quadruple therapies.
AB - © The Author 2015. Background: The cure rate of standard triple therapy for Helicobacter pylori infection is unacceptably low. Susceptibility-guided therapies (SGTs) have been proposed as an alternative to standard empirical treatments. The aim of this study was to perform a systematic review and meta-analysis evaluating the efficacy of SGTs. Methods: A systematic search was performed in multiple databases. Randomized controlled trials comparing cure rates of SGTs versus those of empirical therapy were selected and analysed separately for first- and second-line treatments. A meta-analysis was performed using risk ratio (RR) and number needed to treat (NNT) to measure the effect. Results: Twelve studies were included in the meta-analysis. In first-line treatment, SGTwas more efficacious than empirical 7-10 day triple therapy (RR 1.16, 95% CI 1.10-1.23, I2 = 33%; NNT = 8). Most studies used a 7-10 day triple therapy and randomized the patients after endoscopy and/or culture, thus precluding the comparison of SGT versus non-invasive testing and empirical treatment in clinical practice. For second-line therapy, only four studies were found. Results were highly heterogeneous and no significant differences were found (RR 1.11, 95% CI 0.82-1.51, I2 = 87%). Conclusions: Once endoscopy and culture have been performed, SGT is superior to empirical 7 or 10 day triple therapy for first-line treatment. Further studies are needed to evaluate the effectiveness of SGT in clinical practice, especially when compared with currently recommended first-line quadruple therapies.
U2 - https://doi.org/10.1093/jac/dkv155
DO - https://doi.org/10.1093/jac/dkv155
M3 - Article
VL - 70
SP - 2447
EP - 2455
ER -