PMID- 32079208
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 9
IP  - 2
DP  - 2020 Feb 17
TI  - Clarithromycin Versus Metronidazole in First-Line Helicobacter Pylori Triple 
      Eradication Therapy Based on Resistance to Antimicrobial Agents: Meta-Analysis.
LID - 10.3390/jcm9020543 [doi]
LID - 543
AB  - BACKGROUND: International treatment guidelines for Helicobacter pylori infection 
      recommend a proton pump inhibitor (PPI)/amoxicillin/clarithromycin (CAM) regimen 
      (PAC) or PPI/amoxicillin/metronidazole (MNZ) regimen (PAM) as first-line therapy 
      based on culture and sensitivity testing. As incidence rates of antimicrobial 
      agent-resistant strains are changing year by year, it is important to reevaluate 
      the efficacy of eradication regimens. We performed a meta-analysis to evaluate 
      the efficacy and safety of PAC and PAM based on different locations categorized 
      by the reported incidence of CAM- and MNZ-resistant strains. METHODS: Randomized 
      control trials (RCTs) comparing eradication rates between PAC and PAM first-line 
      treatment up to December 2018 were included. We divided RCTs into four groups 
      based on resistance to CAM (< 15% or >/= 15%) and MNZ (< 15% or >/= 15%). RESULTS: A 
      total of 27 studies (4825 patients) were included. Overall eradication rates 
      between PAC and PAM were similar (74.8% and 72.5%, relative risk (RR): 1.13, 95% 
      confidence interval (CI): 0.91-1.39, P = 0.27) in the intention-to-treat 
      analysis. In areas with low MNZ- and high CAM-resistance rates, PAM had a 
      significantly higher eradication rate than PAC (92.5% vs. 70.8%, RR: 0.29, 95% 
      CI: 0.13-0.68). In areas with high MNZ- and low CAM-resistance rates, the 
      eradication rate with PAC was only 72.9%. CONCLUSIONS: Overall eradication rates 
      with PAC and PAM were equivalent worldwide. In low MNZ-resistance areas, PAM may 
      be recommended as first-line therapy. However, the efficacy of PAC may be 
      insufficient, irrespective of susceptibility to CAM.
FAU - Murata, Masaki
AU  - Murata M
AD  - Department of Gastroenterology, Shiga University of Medical Science Hospital, 
      Otsu, Shiga 520-2192, Japan.
AD  - Department of Gastroenterology, National Hospital Organization Kyoto Medical 
      Center, Fushimi, Kyoto 612-8555, Japan.
FAU - Sugimoto, Mitsushige
AU  - Sugimoto M
AUID- ORCID: 0000-0002-9194-7392
AD  - Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, 
      Otsu, Shiga 520-2192, Japan.
AD  - Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, 
      Shinjuku, Tokyo 160-0023, Japan.
FAU - Mizuno, Hitomi
AU  - Mizuno H
AUID- ORCID: 0000-0003-1535-5384
AD  - Toyoda Aoba Clinic, Iwata, Shizuoka 438-0821, Japan.
FAU - Kanno, Takeshi
AU  - Kanno T
AUID- ORCID: 0000-0001-7305-5924
AD  - Division of Gastroenterology, Tohoku University Hospital, Sendai, Miyagi 
      980-8578, Japan.
FAU - Satoh, Kiichi
AU  - Satoh K
AD  - Department of Gastroenterology, International University of Health and Welfare 
      Hospital, Nasushiobara, Tochigi 329-2763, Japan.
LA  - eng
PT  - Journal Article
DEP - 20200217
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC7073899
OTO - NOTNLM
OT  - Helicobacter pylori
OT  - clarithromycin
OT  - eradication therapy
OT  - metronidazole
OT  - resistant
OT  - triple therapy
COIS- None of the authors have any conflicts of interest related to this study.
EDAT- 2020/02/23 06:00
MHDA- 2020/02/23 06:01
PMCR- 2020/02/17
CRDT- 2020/02/22 06:00
PHST- 2020/01/28 00:00 [received]
PHST- 2020/02/09 00:00 [revised]
PHST- 2020/02/12 00:00 [accepted]
PHST- 2020/02/22 06:00 [entrez]
PHST- 2020/02/23 06:00 [pubmed]
PHST- 2020/02/23 06:01 [medline]
PHST- 2020/02/17 00:00 [pmc-release]
AID - jcm9020543 [pii]
AID - jcm-09-00543 [pii]
AID - 10.3390/jcm9020543 [doi]
PST - epublish
SO  - J Clin Med. 2020 Feb 17;9(2):543. doi: 10.3390/jcm9020543.