title: Role of concomitant therapy forHelicobacter pylorieradication: A technical note.
abstract: We read with interest the recent meta-analysis by Lin et al who evaluated the effectiveness of concomitant regimen forHelicobacter pylori(H. pylori) in Chinese regions. They found that 7-d concomitant regimen is undoubtedly superior to 7-d triple therapy (91.2%vs77.9%,P< 0.0001). However, it is a common belief that a triple therapy lasting 7 d should be definitively removed from the clinical practice for its ineffectiveness. Only its prolongation to 14 d may give satisfactory success rate. Thus, the assessment of an old and outdated treatment versus a more recent and successful one does not seem to bring novel and useful information. Moreover, a 7-d duration has not been ascertained for concomitant regimen, as main guidelines recommend a 10-d schedule for this scheme. Therefore, only studies comparing 10-d concomitant versus 14-d triple seem to be appropriate according to current Guidelines and would clarify which regimen is the most suitable worldwide. Additionally, in this meta-analysis concomitant and sequential therapy showed similar performances, despite it is common opinion that sequential is more prone than concomitant therapy to fail when metronidazole resistance occurs, and China is characterized by high rate of resistance to this antibiotic. None of the included studies evaluateda prioriantibiotic resistances, and the lack of this detail hampers the unveiling of this apparent contradiction. In conclusion, the lack of the evaluation of the quality of included trials as well as their high heterogeneity constitute a burdensome limit to draw solid conclusions in this meta-analysis. On the bases of these considerations and the low number of examined trials, we believe that further studies and the knowledge of antibiotic resistances will support with high quality evidence which is the best regimen and its optimal duration.
authors: Giuseppe Losurdo, Floriana Giorgio, Andrea Iannone, Mariabeatrice Principi, Michele Barone, Alfredo Di Leo, Enzo Ierardi, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors: Giuseppe
authors: G
authors: Losurdo
authors: Giuseppe Losurdo, Floriana Giorgio, Andrea Iannone, Mariabeatrice Principi, Michele Barone, Alfredo Di Leo, Enzo Ierardi, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors: Floriana
authors: F
authors: Giorgio
authors: Giuseppe Losurdo, Floriana Giorgio, Andrea Iannone, Mariabeatrice Principi, Michele Barone, Alfredo Di Leo, Enzo Ierardi, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors: Andrea
authors: A
authors: Iannone
authors: Giuseppe Losurdo, Floriana Giorgio, Andrea Iannone, Mariabeatrice Principi, Michele Barone, Alfredo Di Leo, Enzo Ierardi, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors: Mariabeatrice
authors: M
authors: Principi
authors: Giuseppe Losurdo, Floriana Giorgio, Andrea Iannone, Mariabeatrice Principi, Michele Barone, Alfredo Di Leo, Enzo Ierardi, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors: Michele
authors: M
authors: Barone
authors: Giuseppe Losurdo, Floriana Giorgio, Andrea Iannone, Mariabeatrice Principi, Michele Barone, Alfredo Di Leo, Enzo Ierardi, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors: Alfredo
authors: A
authors: Di Leo
authors: Giuseppe Losurdo, Floriana Giorgio, Andrea Iannone, Mariabeatrice Principi, Michele Barone, Alfredo Di Leo, Enzo Ierardi, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors: Enzo
authors: E
authors: Ierardi
mesh_terms: D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D017291:Clarithromycin / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin
keywords: Antibiotic resistances; Concomitant; Eradication; Helicobacter pylori; Sequential; Triple therapy