Susceptibility testing alone will not reliably achieve high Helicobacter pylori cure rates: A systematic review and meta-analysis
Yu Huang
Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Search for more papers by this authorJinnan Chen
Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Search for more papers by this authorZhaohui Ding
Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Search for more papers by this authorXiao Liang
Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Search for more papers by this authorCorresponding Author
Hong Lu
Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Correspondence
Hong Lu, Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiaotong University School of Medicine, 145 Middle Shandong Road, Shanghai 200001, China.
Email: [email protected]
Search for more papers by this authorYu Huang
Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Search for more papers by this authorJinnan Chen
Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Search for more papers by this authorZhaohui Ding
Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Search for more papers by this authorXiao Liang
Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Search for more papers by this authorCorresponding Author
Hong Lu
Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Correspondence
Hong Lu, Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiaotong University School of Medicine, 145 Middle Shandong Road, Shanghai 200001, China.
Email: [email protected]
Search for more papers by this authorDeclaration of conflict of interest: All authors declare that there is no conflict of interest.
Author contribution: Study concept and study supervision: HL; Study design: YH, XL and HL; Data collection and/or data interpretation: YH, JNC and ZHD; Data analysis: YH, XL and HL; Manuscript drafting: YH and HL; Approval of the final manuscript: YH, JNC, ZHD, XL and HL; Guarantor of the article: Hong Lu.
Financial support: This study was supported by the grant from National Natural Science Foundation of China (81970497 and 82170578) and Clinical Research Center of Shanghai Jiao Tong University School of Medicine (DLY201608).
Abstract
Background and Aim
Not all the susceptibility-guided therapies for Helicobacter pylori (H. pylori) infection achieve excellent eradication rates. The aim of this study was to perform a systematic review and meta-analysis to identify the optimal regimen for H. pylori treatment based on antibiotic susceptibility.
Methods
A systematic search was performed in multiple databases. Studies reporting eradication rates of H. pylori with susceptibility-guided therapies were selected. Meta-analysis was conducted to calculate the pooled eradication rate among the treatment regimens.
Results
Forty-eight eligible studies with 101 susceptibility-guided treatment arms were included. The overall eradication rate in patients harboring susceptible strains was 95.0% (95% CI, 94.1–95.9%), but only 63.4% of treatment arms (64/101) achieved good eradication rates (≥ 90%). Pooled eradication rates in patients with susceptible strains were: 93.4% (95% CI, 92.0–94.8%) for clarithromycin, 99.0% (95% CI, 98.1–100%) for nitroimidazoles and 95.4% (95% CI, 93.6–97.2%) for fluoroquinolones. Among the arms using a triple therapy, 66.7% (28/42) using clarithromycin, 84.2% (16/19) using nitroimidazoles and 70.8% (17/24) using fluoroquinolones achieved good (≥ 90%) eradication rates. Of 13 arms using sequential therapy, ≥ 90% eradication was achieved in 14.3% (1/7) using clarithromycin, 25.0% (1/4) using nitroimidazoles and both arms (2/2) using fluoroquinolones.
Conclusions
Susceptibility testing alone seemed insufficient to reliably attain high H. pylori cure rates. The eradication rate in patients with nitroimidazoles susceptible strains was higher than those of fluoroquinolones and clarithromycin.
Supporting Information
| Filename | Description |
|---|---|
| jgh15864-sup-0001-Supplementary materials 202203.docxWord 2007 document , 2.8 MB |
Table S1. MOOSE Checklist. Table S2. Search strategy performed in main databases. Table S3. Studies excluded from the eligible articles. Table S4. Risk of bias of the studies included. Table S5. Eradication rates for regimens containing clarithromycin in patients infected by “in vitro” susceptible strains. Table S6. Eradication rates for regimens containing nitroimidazoles in patients infected by “in vitro” susceptible strains. Table S7. Eradication rates for regimens containing fluoroquinolones in patients infected by “in vitro” susceptible strains. Table S8. Eradication rates for regimens containing clarithromycin/nitroimidazoles/quinolones in patients infected by “in vitro” susceptible strains in each arm of each study. Table S9. Eradication rates for regimens containing clarithromycin/nitroimidazoles/quinolones in patients infected by “in vitro” susceptible strains for first-line Helicobacter pylori treatment in each arm of each study. Table S10. Eradication rates for regimens containing clarithromycin/nitroimidazoles/quinolones in patients infected by “in vitro” susceptible strains for second-line H. pylori treatment in each arm of each study. Table S11. Eradication rates for regimens containing clarithromycin/nitroimidazoles/quinolones in patients infected by “in vitro” susceptible strains for third-line H. pylori treatment in each arm of each study. Table S12. PP and ITT eradication rates for regimens containing clarithromycin/nitroimidazoles/fluoroquinolones in patients infected by “in vitro” susceptible strains. Figure S1. Pooled eradication rate in patients harboring a clarithromycin-susceptible strain (a. triple therapy, b. triple therapy plus bismuth, c. sequential therapy). Figure S2. Pooled eradication rate in patients harboring a nitroimidazoles-susceptible strain (a. triple therapy, b. triple therapy plus bismuth, c. sequential therapy). Figure S3. Pooled eradication rate in patients harboring a fluoroquinolones-susceptible strain (a. triple therapy, b. triple therapy plus bismuth, c. sequential therapy). Figure S4. Pooled eradication rate in patients harboring susceptible strains (a. first-line, b. second-line, c, third-line). Figure S5. Pooled eradication rate for first-line H. pylori treatment in patients harboring susceptible strains (a. clarithromycin, b. nitroimidazoles, c. fluoroquinolones). Figure S6. Pooled eradication rate for first-line H. pylori treatment in patients harboring susceptible strains (a. triple therapy for clarithromycin, b. triple therapy plus bismuth for clarithromycin, c. sequential therapy for clarithromycin, d. triple therapy for nitroimidazoles, e. sequential therapy for nitroimidazoles, f. triple therapy for fluoroquinolones). Figure S7. Pooled eradication rate for second-line/third-line H. pylori treatment in patients harboring susceptible strains(a.triple therapy for clarithromycin, b. triple therapy for nitroimidazoles, c. triple therapy for fluoroquinolones). |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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