Comparative effectiveness and tolerance of treatments for Helicobacter pylori: systematic review and network meta-analysis.
OBJECTIVE
To determine the most efficacious treatment for eradication of Helicobacter pylori with the lowest likelihood of some common adverse events among pre-recommended and newer treatment regimens.


METHODS
Systematic review and network meta-analysis.


METHODS
Cochrane Library, PubMed, and Embase without language or date restrictions.


METHODS
Full text reports of randomised controlled trials that compared different eradication treatments for H pylori among adults.


RESULTS
Of the 15,565 studies identified, 143 were eligible and included. Data on 14 kinds of treatments were available. Of 91 possible comparisons for the efficacy outcome, 34 were compared directly and the following treatments performed better: seven days of concomitant treatment (proton pump inhibitor and three kinds of antibiotics administered together), 10 or 14 days of concomitant treatment, 10 or 14 days of probiotic supplemented triple treatment (standard triple treatment which is probiotic supplemented), 10 or 14 days of levofloxacin based triple treatment (proton pump inhibitor, levofloxacin, and antibiotic administered together), 14 days of hybrid treatment (proton pump inhibitor and amoxicillin used for seven days, followed by a proton pump inhibitor, amoxicillin, clarithromycin, and 5-nitroimidazole for another seven days), and 10 or 14 days of sequential treatment (five or seven days of a proton pump inhibitor plus amoxicillin, followed by five or seven additional days of a proton pump inhibitor plus clarithromycin and 5-nitroimidazole or amoxicillin). In terms of tolerance, all treatments were considered tolerable, but seven days of probiotic supplemented triple treatment and seven days of levofloxacin based triple treatment ranked best in terms of the proportion of adverse events reported.


CONCLUSIONS
Comparison of different eradication treatments for H pylori showed that concomitant treatments, 10 or 14 days of probiotic supplemented triple treatment, 10 or 14 days of levofloxacin based triple treatment, 14 days of hybrid treatment, and 10 or 14 days of sequential treatment might be better alternatives for the eradication of H pylori.
Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China Anhui Provincial Laboratory of Population Health and Major Disease Screening and Diagnosis, Anhui Medical University, Hefei, Anhui, People's Republic of China.
Bao-Zhu
BZ
Li
Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
Diane Erin
DE
Threapleton
Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Ji-Yao
JY
Wang
Department of Gastroenterology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.
Jian-Ming
JM
Xu
Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
Jin-Qiu
JQ
Yuan
Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China Anhui Provincial Laboratory of Population Health and Major Disease Screening and Diagnosis, Anhui Medical University, Hefei, Anhui, People's Republic of China.
Chao
C
Zhang
Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China Anhui Provincial Laboratory of Population Health and Major Disease Screening and Diagnosis, Anhui Medical University, Hefei, Anhui, People's Republic of China.
Peng
P
Li
The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China ydq@ahmu.edu.cn.
Qian-Ling
QL
Ye
The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.
Biao
B
Guo
Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China The Hong Kong Branch of The Chinese Cochrane Centre, The Chinese University of Hong Kong, Hong Kong, China.
Chen
C
Mao
Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China Anhui Provincial Laboratory of Population Health and Major Disease Screening and Diagnosis, Anhui Medical University, Hefei, Anhui, People's Republic of China ydq@ahmu.edu.cn.
Dong-Qing
DQ
Ye
D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D064704:Levofloxacin / Q000627:therapeutic use; D008795:Metronidazole / Q000627:therapeutic use; D009593:Nitroimidazoles / Q000627:therapeutic use; D019936:Probiotics / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D009593:Nitroimidazoles; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D064704:Levofloxacin; D000658:Amoxicillin; D017291:Clarithromycin; C052587:4-nitroimidazole