Fourth-generation quinolones in the treatment of Helicobacter pylori infection: a meta-analysis

摘要

AIM To assess the efficacy and safety of fourth-generation quinolones for helicobacter pylori(h. pylori) eradication, we conducted this systematic review and metaanalysis of randomized clinical trials. METHODS Major literature databases(Pub Med, EMBASE and the Cochrane Central Register of Controlled Trials) were searched for relevant articles published prior to February 2018. We performed a meta-analysis of all randomized clinical trials that examined the efficacy of h. pylori eradication therapies and included fourthgeneration quinolones in the experimental arm. Subgroup analyses by regions and different types of fourth-generation quinolones were also performed.RESULTS Ten studies including a total of 2198 patients were assessed. A meta-analysis of randomized controlled trials showed that the eradication rate of therapies containing non-fourth-generation quinolones was significantly lower than that of therapies containing fourth-generation quinolones by intention-to-treat(ITT) analysis [75.4% vs 81.8%; odds ratio(OR) = 0.661; 95% confidence interval(CI): 0.447-0.977; P = 0.038]. This analysis also showed that the eradication rate of the therapies containing non-fourth-generation quinolones was inferior to that of therapies containing fourth-generation quinolones by perprotocol analysis(79.1% vs 84.7%; OR = 0.663; 95%CI: 0.433-1.016; P = 0.059). Moreover, the occurrence of side effects was significantly different between the control and experimental groups by ITT analysis(30.6% vs 19.5%; OR = 1.874; 95%CI: 1.120-3.137; P = 0.017). The sub-analyses also showed significant differences in moxifloxacin therapies vs other fourth-generation quinolone therapies(84.3% vs 71.9%) and in Asian vs European groups(76.7% vs 89.1%).CONCLUSION Therapies containing fourth-generation quinolones achieved a poor eradication rate in the treatment of h. pylori infection. Such regimens might be useful as a rescue treatment based on antimicrobial susceptibility testing. Different antibiotics should be chosen in different regions.