Open AccessSequential vs. prolonged 14‐day triple therapy for Helicobacter pylori eradication: the meta‐analysis may be influenced by ‘geographical weighting’
Author(s) -
Losurdo G.,
Leandro G.,
Principi M.,
Giorgio F.,
Montenegro L.,
Sorrentino C.,
Ierardi E.,
Di Leo A.
Publication year - 2015
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.12687
Subject(s) - medicine , meta analysis , regimen , relative risk , metronidazole , clarithromycin , confidence interval , helicobacter pylori , study heterogeneity , antibiotics , microbiology and biotechnology , biology
Summary Background Sequential therapy is a first‐line regimen obtaining satisfactory Helicobacter pylori eradication. Triple therapy prolongation improves the success rate even if a recent meta‐analysis showed satisfying results only for the 14‐day regimen. Studies from Africa and North America were unavailable in previous meta‐analyses. Aim To perform a meta‐analysis comparing sequential vs. prolonged 14‐day triple therapy with regard to ‘geographic weighting’ by considering subgroups analysis according to metronidazole/clarithromycin low and high resistance areas. Methods Based on PRISMA recommendations, we considered all first‐line clinical studies from 2003 to November 2014. Randomised clinical trials ( RCT s) were included by a search on PubMed, MEDLINE , Science Direct, EMBASE . Data on eradication rates were expressed as ITT . Risk ratio ( RR ), pooled RR and 95% confidence intervals were calculated by the Mantel‐Haenszel method. Data were entered into RevMan 5.2 software (Nordic Cochrane Centre) using a random‐effects model. Results Databases identified 194 studies; seven met the inclusion criteria. Overall results showed a similar effectiveness of the two regimens considered ( RR = 0.99; 95% CI = 0.94–1.05; p = 0.75). In areas with high resistance to clarithromycin, sequential was superior to 14‐day triple therapy ( RR = 0.95; 95% CI = 0.90–1.00; p = 0.03). In areas with high metronidazole resistance, sequential and 14‐day triple therapy were equivalent ( RR = 0.99; 95% CI = 0.91–1.08; p = 0.82). Conclusions ‘Geographic weighting’ could be the main factor affecting the lack of differences between sequential and 14‐day triple therapy outcomes.