Pooled analysis on the efficacy of the second-line treatment regimens for Helicobacter pylori infection.
BACKGROUND
Although many of the currently available Helicobacter pylori eradication regimens fail to cure 5%-12% of patients, an optimal re-treatment therapy for eradication-failure patients has still not been established. The aim of this study was to examine all reports concerning the efficacy of re-eradication regimens for H. pylori infection, and to establish optimal re-eradication regimens.


METHODS
Studies concerning re-eradication regimens were retrieved from the MEDLINE database, reference lists and major congress abstract lists up through December 1999. Data from all selected reports were pooled into several groups depending on second-line or initial therapies. Pooled eradication rates of re-treatment regimens were compared using Fisher's exact test (P < 0.05).


RESULTS
Sixteen articles and 24 abstracts with 75 total treatment arms were included in this study. Pooled re-eradication rates by proton-pump inhibitor (PPI)-based dual therapy, PPI-based triple therapy, ranitidine bismuth-based triple therapy and quadruple therapy were 45.8%, 69.8%, 80.2% and 75.8%, respectively. Eradication rates from studies with two new antimicobials added were higher than rates from studies with only one new antimicrobial added (P = 0.0064).


CONCLUSIONS
Ranitidine bismuth-based triple therapies, as well as quadruple therapies, seem to be the most effective re-treatment therapies in all currently undertaken therapies. The strategy of adding two new antimicrobials to previous regimens was also effective in re-eradication therapy.
Hojo
M
M
Dept. of Gastroenterology, Juntendo University, School of Medicine, Tokyo, Japan.
Miwa
H
H
Nagahara
A
A
Sato
N
N
D045784:Abietanes; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D004224:Diterpenes / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D009853:Omeprazole / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D011899:Ranitidine / Q000627:therapeutic use; D012008:Recurrence; D012107:Research Design / Q000592:standards; D013752:Tetracycline / Q000627:therapeutic use; D016896:Treatment Outcome
D045784:Abietanes; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D004224:Diterpenes; D054328:Proton Pump Inhibitors; D008795:Metronidazole; C061681:ecabet; D000658:Amoxicillin; D011899:Ranitidine; D013752:Tetracycline; D017291:Clarithromycin; D009853:Omeprazole