OBJECTIVE To determine the most efficacious treatment for eradication of Helicobacter pylori with the lowest likelihood of some common adverse events among pre-recommended and newer treatment regimens.DESIGN Systematic review and network meta-analysis.DATA SOURCES Cochrane Library,PubMed,and Embase without language or date restrictions.STUDY SELECTION Full text reports of randomised controlled trials that compared different eradication treatments for H pylori among adults.RESULTS Of the 15 565 studies identified,143 were eligible and included.Data on 14 kinds of treatments were available.Of 91 possible comparisons for the efficacy outcome,34 were compared directly and the following treatments performed better: seven days of concomitant treatment(proton pump inhibitor and three kinds of antibiotics administered together),10 or 14 days of concomitant treatment,10 or 14 days of probiotic supplemented triple treatment(standard triple treatment which is probiotic supplemented),10 or 14 days of levofloxacin based triple treatment(proton pump inhibitor,levofloxacin,and antibiotic(proton pump inhibitor and amoxicillin used for seven days,followed by a proton pump inhibitor,amoxicillin,clarithromycin,and 5-nitroimidazole for another seven days),and 10 or 14 days of sequential treatment(five or seven days of a proton pump inhibitor plus amoxicillin,followed by five or seven additional days of a proton pump inhibitor plus clarithromycin and 5-nitroimidazole or amoxicillin).In terms of tolerance,all treatments were considered tolerable,but seven days of probiotic supplemented triple treatment and seven days of levofloxacin based triple treatment ranked best in terms of the proportion of adverse events reported.CONCLUSION Comparison of different eradication treatments for H pylori showed that concomitant treatments,10 or 14 days of probiotic supplemented triple treatment,10 or 14 days of levofloxacin based triple treatment,14 days of hybrid treatment,and 10 or 14 days of sequential treatment might be better alternatives for the eradication of H pylori.
Bao-Zhu Li Diane Erin Threapleton Ji-Yao Wang Jian-Ming Xu Jin-Qiu Yuan Chao Zhang Peng Li Qian-Ling Ye Biao Guo Chen Mao Dong-Qing Ye
Department of Epidemiology and Biostatistics,School of Public Health,Anhui Medical University,Hefei, Division of Epidemiology,The Jockey Club School of Public Health and Primary Care,The Chinese Univer Department of Gastroenterology,Zhongshan Hospital,Fudan University,Shanghai,People”s Republic of Chi Department of Gastroenterology,the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui The Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui,People”s Republic of China Division of Epidemiology,The Jockey Club School of Public Health and Primary Care,The Chinese Univer