What are the global response rates to Helicobacter pylori eradication therapy?
OBJECTIVE
To perform a systematic review of the world literature to determine current success rates of Helicobacter pylori eradication treatment.


METHODS
Computer searches were performed to identify systematic reviews or meta-analyses of treatment studies of H pylori infection. The searches included specifications for Asia, Africa, North America, South America and Europe.


RESULTS
The data supported the current worldwide recommendation to use proton pump inhibitor (PPI)-based triple therapy with clarithromycin and either metronidazole or amoxycillin. There are, however, regional differences in success rates that are not completely explained by resistance to either metronidazole or amoxycillin. For second-line therapy, quadruple therapy using a PPI with bismuth, metronidazole and tetracycline (PPI-BMT) is superior to an alternative PPI-based triple therapy.


CONCLUSIONS
There is worldwide consensus that PPI-based triple therapy, preferably with clarithromycin and amoxycillin or clarithromycin and metronidazole, is used as first-line therapy. Quadruple therapy of PPI-BMT is the preferred rescue medication after initial failure of therapy.
Nash
Christopher
C
Department of Medicine, Dalhousie University, QE II Health Sciences Centre, Victoria General Site, 1278 Tower Road, Halifax, Nova Scotia B3H 2Y9, Canada.
Fischbach
Lori
L
Veldhuyzen van Zanten
Sander
S
D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D014943:Global Health; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D013752:Tetracycline / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D013752:Tetracycline; D017291:Clarithromycin