Triple vs. quadruple therapy for treating Helicobacter pylori infection: an updated meta‐analysis

Abstract

Triple vs. quadruple therapy for treating Helicobacter pylori infection: an updated meta-analysis Sirs, Since we submitted our paper, ÔTriple vs. quadruple therapy for treating Helicobacter pylori infection: a meta-analysisÕ, for publication in Alimentary Pharmacology and Therapeutics, 1 a new study comparing triple with quadruple therapy has been published. 2 Full-text reports of two of the studies included in the metaanalysis in abstract form have also been published. 3, 4The objective of this letter is to update the meta-analysis using these new results. whereas there are small differences between the abstract and full-text form of the paper by Laine et al. 4The results of our meta-analysis did not change after introducing these modifications ( Figure 1). In the intention-to-treat analysis, eradication was achieved in 449 of 559 patients with quadruple therapy [80%; 95% confidence interval (CI), 77-84%] and in 451 of 569 patients with triple therapy (79%; 95% CI, 74-81%). The odds ratio (Figure 1) was 1.00 (95% CI, 0.64-1.57; P ¼ 1). In the per protocol analysis, eradication was achieved in 421 of 486 patients with quadruple therapy (87%; 95% CI, 84.1-90.5%) and in 435 of 509 patients with triple therapy (85%; 95% CI, 81.4-88.3%). The odds ratio was 0.95 (95% CI, 0.58-1.57; P ¼ 0.9).In conclusion, the update of our meta-analysis suggests that the conclusions of the previous report can be maintained, and that the effectiveness of quadruple and triple therapy is very similar for the initial treatment of H. pylori infection.E. Gené *, X. Calvet , R.

A 10‐day levofloxacin‐based triple therapy in patients who have failed two eradication courses

“…8 Furthermore, triple and quadruple therapies seem to be also roughly equivalent in terms of effectiveness when administered as first-line treatment. 17 Subsequent second-line therapy should use quadruple therapy with a PPI, bismuth, metronidazole and tetracycline, but a recent review on rescue regimens reported as the weighted eradication mean with this rescue treatment was of 77.2% 18 Therefore, it remains a therapeutic dilemma which treatments using in those 20-30% of patients still infected after two eradication courses. In this scenario, the utility of the culture (with consequent antibiotic-susceptibility testing) and the moment when it must be performed after eradication failure are both controversial.…”

Triple, standard quadruple and ampicillin-sulbactam-based quadruple therapies forH pylorieradication: A comparative three-armed randomized clinical trial

“…Some recent studies have compared the efficacy of triple versus quadruple therapy, and a recent meta-analysis has assessed these studies [10] . Eradication rates were not significantly different among patients receiving triple or quadruple therapy.…”

“…Triple therapy given for a 10-d period achieved an intention-totreat eradication rate of 79% compared with 77% for a 7-d period. Quadruple therapy on the other hand gave an intention-to-treat eradication rate of 83% for a 10-d period and 80% for a 7-d period [10] . The eradication rates by intention-to-treat analysis among patients receiving either triple or quadruple therapy in this study were almost similar to those obtained previously [4,10,11] .…”

“…Quadruple therapy on the other hand gave an intention-to-treat eradication rate of 83% for a 10-d period and 80% for a 7-d period [10] . The eradication rates by intention-to-treat analysis among patients receiving either triple or quadruple therapy in this study were almost similar to those obtained previously [4,10,11] . A previous preliminary study by the authors using ampicillin-sulbactam instead of amoxicillin in 10-d standard quadruple therapy on 26 patients has yielded a 92% eradication rate by per-protocol analysis which was well tolerated among patients (unpublished data).…”

Helicobacter pylori: Evidence-Based Review with a Focus on Immigrant Populations

“…28 Studies have shown that the eradication rates with both of these regimens range from 70 % to 85 %. [60][61][62][63] Case Continued. The patient sees you in follow-up, at which time you decide to confirm eradication with a fecal antigen test, which comes back positive.…”