Treatment of Helicobacter pylori infection: a review of the world literature.
BACKGROUND
None of the currently used anti-Helicobacter pylori drug regimens cures the infection 100%, and cure results still vary considerably. The present article reviews the effectiveness of currently used antimicrobial regimens, aimed to cure H. pylori infection.


METHODS
Data collection started from the beginning of the anti-H. pylori-therapy era until May 1995. No attempt at formal metanalysis has been made, because many studies have been published only in abstract form. Attempts were made to exclude duplicates of studies by comparison to previously reported ones; the authors of suspected duplicates were contacted. After amalgamation of the number of included patients and the number of successfully treated patients, the mean values of eradication rates and the 95% confidence intervals were calculated.


RESULTS
A total of 237 treatment arms were analyzed. Bismuth triple therapy continues to reach high eradication rates worldwide (78-89%). Side effects leading to diminished patient compliance and the marked decline of eradication efficacy in cases of metronidazole resistance are considered to be the major drawbacks of this therapy. Proton pump inhibitor (PPI) dual therapy is better tolerated with fewer side effects than is bismuth triple therapy. The mean eradication rates vary from 55 to 75%, and the extremes lie between 24 and 93%. PPI triple therapies have been shown to be very effective against H. pylori (eradication rates, 80-89%). Quadruple therapy leads to a mean eradication rate of 96%.


CONCLUSIONS
Based on efficacy, PPI triple or bismuth triple therapy are recommended as first-line treatment for H. pylori infection. Quadruple therapy could serve as second-line treatment for eradication of initial failures and in case of metronidazole resistance.
van der Hulst
R W
RW
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
Keller
J J
JJ
Rauws
E A
EA
Tytgat
G N
GN
D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D000863:Antacids / Q000008:administration & dosage / Q000627:therapeutic use*; D001729:Bismuth / Q000008:administration & dosage / Q000627:therapeutic use*; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D004791:Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D005756:Gastritis / Q000188:drug therapy* / Q000382:microbiology; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use; D009853:Omeprazole / Q000008:administration & dosage / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D012907:Smoking / Q000009:adverse effects; D013752:Tetracycline / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
D000863:Antacids; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D013752:Tetracycline; D017291:Clarithromycin; D009853:Omeprazole; D001729:Bismuth