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‐...
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| Veröffentlicht in: | Journal of gastroenterology and hepatology 2021-10, Vol.36 (10), p.2649-2658 |
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| container_title | Journal of gastroenterology and hepatology |
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| creator | Gingold‐Belfer, Rachel Niv, Yaron Schmilovitz‐Weiss, Hemda Levi, Zohar Boltin, Doron |
| description | 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 |
| doi_str_mv | 10.1111/jgh.15575 |
| format | Article |
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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 < 0.0001, I2 = 75%). Susceptibility‐guided therapy was superior to first‐line clarithromycin‐based triple therapy only when clarithromycin resistance exceeded 20% (RR, 1.18; 95% CI, 1.07–1.30; P = 0.001, I2 = 81%). Susceptibility‐guided therapy was not more effective than empirical quadruple therapy (RR, 1.02; 95% CI, 0.92–1.13; P = 0.759, I2 = 80%). Three RCTs were performed exclusively among previously treated subjects, and were highly heterogeneous.
Conclusions
Our findings suggest that susceptibility‐guided treatment may be slightly superior to empirical first line triple therapy. Susceptibility‐ guided treatment does not appear to be superior to empirical first‐line quadruple therapy or empirical rescue therapy.</description><identifier>ISSN: 0815-9319</identifier><identifier>EISSN: 1440-1746</identifier><identifier>DOI: 10.1111/jgh.15575</identifier><identifier>PMID: 34114673</identifier><language>eng</language><publisher>Australia: Wiley Subscription Services, Inc</publisher><subject>Anti-Bacterial Agents - adverse effects ; Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; Antibiotic resistance ; Bacteria ; Clarithromycin ; Clarithromycin - adverse effects ; Clarithromycin - therapeutic use ; Clinical trials ; Comparison ; Drug Resistance, Bacterial ; Drug Therapy, Combination - adverse effects ; Drug Therapy, Combination - methods ; Eradication ; Helicobacter Infections - drug therapy ; Helicobacter pylori ; Humans ; Infections ; Meta-analysis ; Microbial Sensitivity Tests ; Patients ; Randomized Controlled Trials as Topic ; RCT ; Susceptibility ; Systematic review ; Tailored ; Treatment Outcome</subject><ispartof>Journal of gastroenterology and hepatology, 2021-10, Vol.36 (10), p.2649-2658</ispartof><rights>2021 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd</rights><rights>2021 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4195-7ffa1cdae410bce335a109582d8205c614aa2ef2959af6b767dfad6d250f8cf13</citedby><cites>FETCH-LOGICAL-c4195-7ffa1cdae410bce335a109582d8205c614aa2ef2959af6b767dfad6d250f8cf13</cites><orcidid>0000-0002-2831-4402 ; 0000-0003-3357-613X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgh.15575$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgh.15575$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34114673$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gingold‐Belfer, Rachel</creatorcontrib><creatorcontrib>Niv, Yaron</creatorcontrib><creatorcontrib>Schmilovitz‐Weiss, Hemda</creatorcontrib><creatorcontrib>Levi, Zohar</creatorcontrib><creatorcontrib>Boltin, Doron</creatorcontrib><title>Susceptibility‐guided versus empirical treatment for Helicobacter pylori infection: A systematic review and meta‐analysis</title><title>Journal of gastroenterology and hepatology</title><addtitle>J Gastroenterol Hepatol</addtitle><description>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 < 0.0001, I2 = 75%). Susceptibility‐guided therapy was superior to first‐line clarithromycin‐based triple therapy only when clarithromycin resistance exceeded 20% (RR, 1.18; 95% CI, 1.07–1.30; P = 0.001, I2 = 81%). Susceptibility‐guided therapy was not more effective than empirical quadruple therapy (RR, 1.02; 95% CI, 0.92–1.13; P = 0.759, I2 = 80%). Three RCTs were performed exclusively among previously treated subjects, and were highly heterogeneous.
Conclusions
Our findings suggest that susceptibility‐guided treatment may be slightly superior to empirical first line triple therapy. Susceptibility‐ guided treatment does not appear to be superior to empirical first‐line quadruple therapy or empirical rescue therapy.</description><subject>Anti-Bacterial Agents - adverse effects</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotic resistance</subject><subject>Bacteria</subject><subject>Clarithromycin</subject><subject>Clarithromycin - adverse effects</subject><subject>Clarithromycin - therapeutic use</subject><subject>Clinical trials</subject><subject>Comparison</subject><subject>Drug Resistance, Bacterial</subject><subject>Drug Therapy, Combination - adverse effects</subject><subject>Drug Therapy, Combination - methods</subject><subject>Eradication</subject><subject>Helicobacter Infections - drug therapy</subject><subject>Helicobacter pylori</subject><subject>Humans</subject><subject>Infections</subject><subject>Meta-analysis</subject><subject>Microbial Sensitivity Tests</subject><subject>Patients</subject><subject>Randomized Controlled Trials as Topic</subject><subject>RCT</subject><subject>Susceptibility</subject><subject>Systematic review</subject><subject>Tailored</subject><subject>Treatment Outcome</subject><issn>0815-9319</issn><issn>1440-1746</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kb1u1TAUgC0EopfCwAsgSyxlSOuT2EnMVlXQS1WpAzBHjn1cfOX8YDutMiDxCDwjT4LLbRmQ6uUsn75zrI-Q18COIb-T3fW3YxCiEU_IBjhnBTS8fko2rAVRyArkAXkR444xxlkjnpODigPwuqk25MfnJWqck-udd2n9_fPX9eIMGnqDIS6R4jC74LTyNAVUacAxUTsFukXv9NQrnTDQefVTcNSNFnVy0_ientK4xoSDSk7TgDcOb6kaDR0wqbxDjcqv0cWX5JlVPuKr-3lIvn788OVsW1xenX86O70sNAcpisZaBdoo5MB6jVUlFDAp2tK0JRO6Bq5UibaUQipb903dGKtMbUrBbKstVIfkaO-dw_R9wZi6weVve69GnJbYlYIzATLLMvr2P3Q3LSHfe0c1UnKoRJupd3tKhynGgLabgxtUWDtg3V2TLjfp_jbJ7Jt749IPaP6RDxEycLIHbp3H9XFTd3G-3Sv_AHqhmkc</recordid><startdate>202110</startdate><enddate>202110</enddate><creator>Gingold‐Belfer, Rachel</creator><creator>Niv, Yaron</creator><creator>Schmilovitz‐Weiss, Hemda</creator><creator>Levi, Zohar</creator><creator>Boltin, Doron</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2831-4402</orcidid><orcidid>https://orcid.org/0000-0003-3357-613X</orcidid></search><sort><creationdate>202110</creationdate><title>Susceptibility‐guided versus empirical treatment for Helicobacter pylori infection: A systematic review and meta‐analysis</title><author>Gingold‐Belfer, Rachel ; Niv, Yaron ; Schmilovitz‐Weiss, Hemda ; Levi, Zohar ; Boltin, Doron</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4195-7ffa1cdae410bce335a109582d8205c614aa2ef2959af6b767dfad6d250f8cf13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Anti-Bacterial Agents - adverse effects</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotic resistance</topic><topic>Bacteria</topic><topic>Clarithromycin</topic><topic>Clarithromycin - adverse effects</topic><topic>Clarithromycin - therapeutic use</topic><topic>Clinical trials</topic><topic>Comparison</topic><topic>Drug Resistance, Bacterial</topic><topic>Drug Therapy, Combination - adverse effects</topic><topic>Drug Therapy, Combination - methods</topic><topic>Eradication</topic><topic>Helicobacter Infections - drug therapy</topic><topic>Helicobacter pylori</topic><topic>Humans</topic><topic>Infections</topic><topic>Meta-analysis</topic><topic>Microbial Sensitivity Tests</topic><topic>Patients</topic><topic>Randomized Controlled Trials as Topic</topic><topic>RCT</topic><topic>Susceptibility</topic><topic>Systematic review</topic><topic>Tailored</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gingold‐Belfer, Rachel</creatorcontrib><creatorcontrib>Niv, Yaron</creatorcontrib><creatorcontrib>Schmilovitz‐Weiss, Hemda</creatorcontrib><creatorcontrib>Levi, Zohar</creatorcontrib><creatorcontrib>Boltin, Doron</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gingold‐Belfer, Rachel</au><au>Niv, Yaron</au><au>Schmilovitz‐Weiss, Hemda</au><au>Levi, Zohar</au><au>Boltin, Doron</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Susceptibility‐guided versus empirical treatment for Helicobacter pylori infection: A systematic review and meta‐analysis</atitle><jtitle>Journal of gastroenterology and hepatology</jtitle><addtitle>J Gastroenterol Hepatol</addtitle><date>2021-10</date><risdate>2021</risdate><volume>36</volume><issue>10</issue><spage>2649</spage><epage>2658</epage><pages>2649-2658</pages><issn>0815-9319</issn><eissn>1440-1746</eissn><abstract>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 < 0.0001, I2 = 75%). Susceptibility‐guided therapy was superior to first‐line clarithromycin‐based triple therapy only when clarithromycin resistance exceeded 20% (RR, 1.18; 95% CI, 1.07–1.30; P = 0.001, I2 = 81%). Susceptibility‐guided therapy was not more effective than empirical quadruple therapy (RR, 1.02; 95% CI, 0.92–1.13; P = 0.759, I2 = 80%). Three RCTs were performed exclusively among previously treated subjects, and were highly heterogeneous.
Conclusions
Our findings suggest that susceptibility‐guided treatment may be slightly superior to empirical first line triple therapy. Susceptibility‐ guided treatment does not appear to be superior to empirical first‐line quadruple therapy or empirical rescue therapy.</abstract><cop>Australia</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34114673</pmid><doi>10.1111/jgh.15575</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-2831-4402</orcidid><orcidid>https://orcid.org/0000-0003-3357-613X</orcidid></addata></record> |
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| ispartof | Journal of gastroenterology and hepatology, 2021-10, Vol.36 (10), p.2649-2658 |
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| subjects | Anti-Bacterial Agents - adverse effects Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Antibiotic resistance Bacteria Clarithromycin Clarithromycin - adverse effects Clarithromycin - therapeutic use Clinical trials Comparison Drug Resistance, Bacterial Drug Therapy, Combination - adverse effects Drug Therapy, Combination - methods Eradication Helicobacter Infections - drug therapy Helicobacter pylori Humans Infections Meta-analysis Microbial Sensitivity Tests Patients Randomized Controlled Trials as Topic RCT Susceptibility Systematic review Tailored Treatment Outcome |
| title | Susceptibility‐guided versus empirical treatment for Helicobacter pylori infection: A systematic review and meta‐analysis |
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