Susceptibility‐guided versus empirical treatment for Helicobacter pylori infection: A systematic review and meta‐analysis

Background and Aim Empirical therapy for Helicobacter pylori infection is limited by increasing antibiotic resistance and suboptimal eradication rates. Studies of the relative effectiveness of susceptibility‐guided therapy have produced conflicting results. We performed a systematic review and meta‐analysis of randomized controlled trials (RCTs) to determine whether susceptibility‐guided therapy is superior to empirical therapy for H. pylori infection. Methods We searched articles listed in PubMed, MEDLINE, EMBASE, and Web of Science through May 25, 2020, RCTs comparing susceptibility‐guided versus empirical therapy for H. pylori infection. Outcomes, including effectiveness and safety, were analyzed in a meta‐analysis. Results Our final analysis included 16 studies, comprising 2374 patients who received susceptibility‐guided therapy and 2451 patients who received empirical treatment. In previously untreated subjects, susceptibility‐guided therapy was slightly more effective than empirical therapy (intent to treat risk ratio [RR], 1.14; 95% confidence interval [CI], 1.07–1.21; P