Sa1913 Clinical Outcomes of Two Weeks Sequential and Concomitant Therapies for Helicobacter pylori Eradication; A Randomized Pilot Study

Abstract

BACKGROUND: Standard triple therapy with PPI, amoxicillin and clarithromycin is the most widely prescribed treatment for Helicobacter pylori infection but it fails in approximately 20% of patients. AIM: To conduct a meta-analysis of second-line studies assessing the efficacy of rescue treatments after failure of standard triple therapy with PPI, amoxicillin and clarithromycin in H. pylori eradication. METHODS: Selection of studies : Second-line studies reporting efficacy -by intention to treatwere used for generic inverse variance, and randomized clinical trials (RCT) for meta-analyses. Inclusion criteria: studies treating H. pyloripositive patients after PPI, amoxicillin and clarithromycin failure. Studies were excluded if diagnostic or confirmation of eradication were made only by serology, PCR or polyclonal stool antigen test, or if second-line treatment was selected depending on antibiotic sensitivity. Search strategy: Bibliographical searches were performed in PubMed up to May 2012. Data synthesis: Intention to treat eradication rate. RESULTS: Although 35 RCT met inclusion criteria, there was not enough information to perform a formal meta-analysis comparing treatments because of the huge number of different comparisons found (n=27). The efficacy of second-line treatment with PPI, levofloxacin and amoxicillin was analyzed by inverse variance: 14 studies were included (1,989 patients); the eradication rate was 74% (95%CI= 0.68-0.80; p,0.001; I=88%), and this effect was higher when treatment was given for 10 days instead of 7 (82% vs. 67%). For PPI, bismuth, tetracycline and metronidazole treatment (24 studies, 1,937 patients) the eradication rate was 77% (95%CI=0.72-0.81; p,0.001; I= 87%). For PPI, amoxicillin and metronidazole (18 studies, 1,357 patients), eradication rate was 90% (95%CI=0.87-0.92; p,0.001; I=58%). Finally, ranitidine-bismuth-citrate, tetracycline and nitroimidazole achieved a 76% eradication rate (6 studies, 358 patients, 95%CI=0.64-0.88; p,0.001; I=86%). CONCLUSION: After failure of first-line eradication treatment with PPI, amoxicillin and clarithromycin, the best options for second-line treatment are a combination of a PPI, amoxicillin and metronidazole or a PPI, levofloxacin and amoxicillin for 10 days.