PMID- 19755966
OWN - NLM
STAT- MEDLINE
DCOM- 20100225
LR  - 20220410
IS  - 1572-0241 (Electronic)
IS  - 0002-9270 (Linking)
VI  - 105
IP  - 1
DP  - 2010 Jan
TI  - Empiric quadruple vs. triple therapy for primary treatment of Helicobacter pylori 
      infection: Systematic review and meta-analysis of efficacy and tolerability.
PG  - 65-73
LID - 10.1038/ajg.2009.508 [doi]
AB  - OBJECTIVES: Recent treatment guidelines recommend two first-line therapies for 
      Helicobacter pylori infection: proton pump inhibitor (PPI), bismuth, 
      tetracycline, and metronidazole (quadruple therapy) or PPI, clarithromycin, and 
      amoxicillin (triple therapy). We performed a systematic review and meta-analysis 
      to compare the efficacy and tolerability of these regimens as first-line 
      treatment of H. pylori. METHODS: A search of MEDLINE, EMBASE, Google Scholar, the 
      Cochrane Central Register of Controlled Trials, ACP Journal Club, the Database of 
      Abstracts of Reviews of Effectiveness, Cochrane Methodology Register, Health 
      Technology Assessment Database, and abstracts from prominent gastrointestinal 
      scientific meetings was carried out. Randomized controlled trials (RCTs) 
      comparing bismuth quadruple therapy to clarithromycin triple therapy were 
      selected for meta-analysis. Two independent reviewers extracted data, using 
      standardized data forms. Meta-analysis was carried out with the metan command in 
      Stata 10.1. Funnel plots and subgroup analyses were carried out. RESULTS: Nine 
      RCTs (N=1,679) were included. Although dosing regimens of clarithromycin triple 
      therapy were quite consistent between trials, dosing regimens varied considerably 
      for bismuth quadruple therapy. Bismuth quadruple therapy achieved eradication in 
      78.3% of patients, whereas clarithromycin triple therapy achieved an eradication 
      rate of 77.0% (risk ratio (RR)=1.002, 95% confidence interval (CI): 0.936-1.073). 
      There was moderate heterogeneity and no evidence for significant publication 
      bias. Subgroup analyses by study location, treatment duration, and study 
      population did not account for the heterogeneity. There were no statistically 
      significant differences in side effects yielded by quadruple vs. clarithromycin 
      triple therapy (RR=1.04, 95% CI: 1.04-1.14). CONCLUSIONS: Quadruple and triple 
      therapies yielded similar eradication rates as primary therapy for H. pylori 
      infection. Both therapies yielded suboptimal eradication rates. Patient 
      compliance and side effects are similar for quadruple and triple therapies.
FAU - Luther, Jay
AU  - Luther J
AD  - University of Michigan Medical Center, Ann Arbor, USA.
FAU - Higgins, Peter D R
AU  - Higgins PD
FAU - Schoenfeld, Phillip S
AU  - Schoenfeld PS
FAU - Moayyedi, Paul
AU  - Moayyedi P
FAU - Vakil, Nimish
AU  - Vakil N
FAU - Chey, William D
AU  - Chey WD
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20090915
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
RN  - 0 (Antacids)
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Anti-Infective Agents)
RN  - 0 (Proton Pump Inhibitors)
RN  - 140QMO216E (Metronidazole)
RN  - 804826J2HU (Amoxicillin)
RN  - F8VB5M810T (Tetracycline)
RN  - H1250JIK0A (Clarithromycin)
RN  - U015TT5I8H (Bismuth)
SB  - IM
MH  - Amoxicillin/therapeutic use
MH  - Antacids/therapeutic use
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Anti-Infective Agents/therapeutic use
MH  - Bismuth/therapeutic use
MH  - Clarithromycin/therapeutic use
MH  - Drug Therapy, Combination
MH  - Helicobacter Infections/*drug therapy
MH  - *Helicobacter pylori
MH  - Humans
MH  - Metronidazole/therapeutic use
MH  - Outcome Assessment, Health Care
MH  - Patient Compliance
MH  - Practice Guidelines as Topic
MH  - Proton Pump Inhibitors/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Tetracycline/therapeutic use
RF  - 38
EDAT- 2009/09/17 06:00
MHDA- 2010/02/26 06:00
CRDT- 2009/09/17 06:00
PHST- 2009/09/17 06:00 [entrez]
PHST- 2009/09/17 06:00 [pubmed]
PHST- 2010/02/26 06:00 [medline]
AID - ajg2009508 [pii]
AID - 10.1038/ajg.2009.508 [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2010 Jan;105(1):65-73. doi: 10.1038/ajg.2009.508. Epub 2009 
      Sep 15.