title: Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection.
abstract: BACKGROUND
  Susceptibility-guided therapies (SGTs) have been proposed as preferable to empirical rescue treatments after two treatment failures. The aim of this study was to perform a systematic review and meta-analysis evaluating the effectiveness and efficacy of SGT as third-line therapy.
  
  
  METHODS
  A systematic search was performed in multiple databases. Studies reporting cure rates of Helicobacter pylori with SGT in third-line therapy were selected. A qualitative analysis describing the current evidence and a pooled mean analysis summarizing the cure rates of SGT in third-line therapy was performed.
  
  
  RESULTS
  No randomized controlled trials or comparative studies were found. Four observational studies reported cure rates with SGT in third-line treatment, and three studies which mixed patients with second- and third-line treatment also reported cure rates with SGT. The majority of the studies included the patients when culture had been already obtained, and so the effectiveness of SGT and empirical therapy has never been compared. A pooled mean analysis including four observational studies (283 patients) showed intention-to-treat and per-protocol eradication rates with SGT of 72% (95% confidence interval 56-87%; I(2) : 92%) and 80% (95% confidence interval 71-90%; I(2) : 80%), respectively.
  
  
  CONCLUSIONS
  SGT may be an acceptable option as rescue treatment. However, cure rates are, at best, moderate and this approach has never been compared with a well-devised empirical therapy. The evidence in favor of SGT as rescue therapy is currently insufficient to recommend its use.
authors.affiliation: Digestive Diseases Unit, Althaia Xarxa Assistencial Universitaria de Manresa. Barcelona, Spain.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Puig
authors.affiliation: Internal Medicine Department, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain.
authors.forename: Sheila
authors.initials: S
authors.lastname: López-Góngora
authors.affiliation: Servei d'Aparell Digestiu, Hospital de Sabadell, Departament de Medicina, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Parc Taulí, 1 08208 Sabadell (Barcelona), Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Calvet
authors.affiliation: Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, 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: Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, 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: Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, 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.
authors.forename: Javier P
authors.initials: JP
authors.lastname: Gisbert
keywords: Helicobacter pylori; susceptibility-guided treatment; tailored treatment; third-line treatment