Azithromycin-containing versus standard triple therapy forHelicobacter pylori eradication: A meta-analysis

Abstract

AIM:To evaluate whether adding azithromycin to firstline Helicobacter pylori (H pylori ) eradication improved eradication and reduced side effects. METHODS:Eligible articles were identified by searches of electronic databases. We included all randomized trials that compared azithromycin-containing with standard triple-therapy regimens for first-line treatment of H pylori infection. Statistical analysis was performed with Review Manager 5.0.10. Sub-analyses were also performed. RESULTS:We identified 14 randomized trials (1431 patients). Pooled H pylori eradication rates were 72.01% (95% CI: 58.09%-85.93%) and 69.78% (95% CI: 66.47%-73.09%) for patients with or without azithromycin by intention-to-treat analysis, and the odds ratio (OR) was 1.17 (95% CI: 0.64-2.14). The occurrence of side effects differed significantly and was 15.81% (95% CI: 12.50%-19.12%) and 25.20% (95% CI: 21.44%-28.96%) for treatment with or without azithromycin, respectively, and the summary OR was 0.58 (95% CI: 0.41-0.82). Furthermore, the azithromycin-containing group had a lower occurrence of diarrhea, nausea and taste disturbance. CONCLUSION:Our review suggests that azithromycincontaining triple-therapy regimens could be equally effective in eradication of H pylori compared with standard first-line triple-therapy regimens.

Intraluminal therapy for Helicobacter pylori infection

“…5,6 This is attributable to the special gastric milieu of H. pylori, which leads to more difficult and complicated treatment regimens to achieve its successful eradication in contrast to other bacterial infections. Several strategies [7][8][9] have been proposed to increase the eradication rate and decrease the antibiotic resistance, including extension of treatment duration, increasing doses, using four-drug nonbismuth-containing (sequential, hybrid, and concomitant) and bismuth-containing quadruple therapies or even five-drug quintuple therapy, 10 use of other antibiotics such as levofloxacin, 9 azithromycin, 11 rifabutin, 12,13 and furazolidone, 14 using a high-dose proton pump inhibitor 15 or a novel potassium-competitive acid blocker (vonoprazan), [16][17][18] dual therapy, 8 use of bismuth-enhanced triple therapy 19 or susceptibility-guided therapy, [20][21][22] and the supplementation of probiotics. 8,23,24 However, the current multiple-dose antibiotic therapies still steadily increase the rate of worldwide antibiotic resistance, which becomes a leading international medical problem.…”

Eradication of Helicobacter pylori in Children by Triple Therapy Regimens of Amoxicillin, Omeprazole, and Clarithromycin or Azithromycin

“…The attending resident was blind to the drugs administered to patients. A questionnaire has been prepared on the basis of previous studies ( 19 ) that evaluated the drug's side effects and intolerance and was completed by the patients or their parents. Four to six weeks after completion of treatment, patients’ stool was tested for H. Pylori with monoclonal method using the Helicobacter Antigen Quick Kit (Generic Assays GmbH, Germany) which has a sensitivity of 85% - 96% and specificity of 83% - 93% ( 22 - 24 ).…”

“…Since azithromycin is a macrolide, it reaches a high concentration in the tissue and remains there for a few days after oral administration; therefore, it can be used in the eradication of H. Pylori ( 14 - 18 ). The eradication rate of azithromycin used in different regimens has been reported 60% to 80% ( 19 ). According to a meta-analysis, its effect is similar to classical regimen and it is better tolerated by patients ( 19 ).…”

“…The eradication rate of azithromycin used in different regimens has been reported 60% to 80% ( 19 ). According to a meta-analysis, its effect is similar to classical regimen and it is better tolerated by patients ( 19 ).…”

New dual therapy for primary treatment of Helicobacter pylori infection: A prospective randomized study in Shanghai, China

“…2,3 However, the efficacy of triple therapy has been decreasing to an unacceptable level, even lower than 70%, in several areas due to an increased antibiotic resistance, especially to clarithromycin, and drug-induced adverse events as well as patients' poor compliance. 4,5 Alternative treatments, such as bismuth-based quadruple therapy, sequential therapy and concomitant therapy, have been developed to achieve higher success rates for H. pylori eradication. 6,7 However, it is difficult to complete the drug therapy in the elderly population or those with insufficient hepatonephric function.…”