title: Systematic review and meta-analysis: susceptibility-guided versus empirical antibiotic treatment for Helicobacter pylori infection.
abstract: BACKGROUND
  The cure rate of standard triple therapy for Helicobacter pylori infection is unacceptably low. Susceptibility-guided therapies (SGTs) have been proposed as an alternative to standard empirical treatments. The aim of this study was to perform a systematic review and meta-analysis evaluating the efficacy of SGTs.
  
  
  METHODS
  A systematic search was performed in multiple databases. Randomized controlled trials comparing cure rates of SGTs versus those of empirical therapy were selected and analysed separately for first- and second-line treatments. A meta-analysis was performed using risk ratio (RR) and number needed to treat (NNT) to measure the effect.
  
  
  RESULTS
  Twelve studies were included in the meta-analysis. In first-line treatment, SGT was more efficacious than empirical 7-10 day triple therapy (RR 1.16, 95% CI 1.10-1.23, I (2) = 33%; NNT = 8). Most studies used a 7-10 day triple therapy and randomized the patients after endoscopy and/or culture, thus precluding the comparison of SGT versus non-invasive testing and empirical treatment in clinical practice. For second-line therapy, only four studies were found. Results were highly heterogeneous and no significant differences were found (RR 1.11, 95% CI 0.82-1.51, I (2) = 87%).
  
  
  CONCLUSIONS
  Once endoscopy and culture have been performed, SGT is superior to empirical 7 or 10 day triple therapy for first-line treatment. Further studies are needed to evaluate the effectiveness of SGT in clinical practice, especially when compared with currently recommended first-line quadruple therapies.
authors.affiliation: Internal Medicine Department, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain.
authors.forename: Sheila
authors.initials: S
authors.lastname: López-Góngora
authors.affiliation: Digestive Diseases Unit, Althaia Xarxa Assistencial, Universitaria de Manresa, Barcelona, Spain Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Departament de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Puig
authors.affiliation: Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Digestive Diseases Unit, Corporació Sanitaria Universitària Parc Taulí, Sabadell, Spain Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Madrid, Spain xcalvet@tauli.cat.
authors.forename: Xavier
authors.initials: X
authors.lastname: Calvet
authors.affiliation: Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Digestive Diseases Unit, Corporació Sanitaria Universitària Parc Taulí, Sabadell, Spain Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Madrid, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Villoria
authors.affiliation: Internal Medicine Department, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Baylina
authors.affiliation: Internal Medicine Department, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain.
authors.forename: Neus
authors.initials: N
authors.lastname: Muñoz
authors.affiliation: Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Digestive Diseases Unit, Corporació Sanitaria Universitària Parc Taulí, Sabadell, Spain Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Madrid, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Sanchez-Delgado
authors.affiliation: Unitat d'Epidemiologia i Avaluació, Hospital de Sabadell, Sabadell, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Suarez
authors.affiliation: Internal Medicine Department, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: García-Hernando
authors.affiliation: Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Madrid, Spain Servicio de Aparato Digestivo, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain.
authors.forename: Javier P
authors.initials: JP
authors.lastname: Gisbert
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D004358:Drug Therapy / Q000379:methods*; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D008826:Microbial Sensitivity Tests; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents