Optimization of Helicobacter pylori eradication therapies

摘要

In the face of rising prevalence of antibiotic resistance, several strategies have been proposed to optimize the efficacies of therapeutic regimens for Helicobacter pylori eradication, including extending the treatment length to 14 days, the use of four drug regimens (hybrid therapy, bismuth quadruple therapy, concomitant therapy, or sequential therapy), the use of high-dose proton pump inhibitor (PPI), or tailored therapy. Meta-analysis of randomized trials showed that 14-day triple therapy was superior to 10-day or 7-day triple therapy. In a recent network meta-analysis, Yeo et al showed the four drug regimens are usually superior to triple therapy when given for the same duration. Concomitant therapy given for 14 days, but not 10 days, was superior to 14-day triple therapy. Randomized trials and meta-analysis also showed that sequential therapy given for 14 days, but not 10 days, was superior to 14-day triple therapy. Therefore, the Toronto and the Maastricht IV Consensus recommended that triple therapy or four drug therapy be given for 14 days.