Optimal Duration of Bismuth-Containing Quadruple Therapy for Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter Pub Date : 2024-10-23 DOI:10.1111/hel.13144

Miao Duan, Qingzhou Kong, Hui Wang, Yueyue Li

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引用次数: 0

Abstract

Background

The eradication of Helicobacter pylori (H. pylori) is crucial due to its rising prevalence and increasing resistance. Bismuth-containing quadruple therapies (BcQTs) have been proposed as a viable treatment option; however, the optimal duration for it remains contentious. This systematic review and meta-analysis aimed to compare the clinical efficacy of short-term BcQT (defined as 7 or 10 days) with a standard 14-day course.

Methods

A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted for randomized controlled trials published in English until June 20, 2024. Eligibility criteria were applied to identify relevant studies. Summary risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for the included studies regarding eradication rates, adverse effects, and compliance. This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was previously registered in PROSPERO under registration number CRD42024547773.

Results

This meta-analysis finally included 15 trials involving a total of 4505 patients. The eradication rates for short courses of BcQT were lower than those for the 14-day course (RR 0.96, 95% CI 0.93–0.99). However, the eradication rate for the 10-day therapy was comparable to that of the 14-day therapy (RR 0.98, 95% CI 0.95–1.00). Subgroup analyses of antibiotic combinations indicated that tetracycline and metronidazole combinations yielded similar H. pylori eradication rates in the 7-day versus the 14-day BcQT (RR 0.93, 95% CI 0.84–1.02). In the potassium-competitive acid blocker subgroup, the eradication rates remained similar across the 14-day group and the short-course treatment groups, whether evaluating the short-term treatment groups as a whole or the 7- and 10-day subgroups separately. Additionally, the adverse effects and compliance associated with the short course of BcQT were comparable to those of the 14-day therapy.

Conclusion

A 10-day course of BcQT may represent the optimal treatment duration. Nevertheless, the choice of antibiotic combination should be guided by the regional antibiotic resistance patterns of H. pylori, as combinations with lower resistance rates are more effective.

Trial Registration

PROSPERO number: CRD42024547773

查看原文本刊更多论文

根除幽门螺旋杆菌的含铋四联疗法的最佳持续时间：系统回顾与元分析》。

背景：由于幽门螺旋杆菌（H. pylori）的发病率不断上升且耐药性不断增强，根除幽门螺旋杆菌（H. pylori）至关重要。含铋四联疗法（BcQTs）被认为是一种可行的治疗方案，但其最佳疗程仍存在争议。本系统综述和荟萃分析旨在比较短期 BcQT（定义为 7 天或 10 天）与 14 天标准疗程的临床疗效：方法：在PubMed、Embase、Web of Science和Cochrane图书馆对2024年6月20日前发表的英文随机对照试验进行了系统检索。采用资格标准来确定相关研究。计算了纳入研究中有关根除率、不良反应和依从性的总风险比 (RR) 和 95% 置信区间 (CI)。本系统综述和荟萃分析根据系统综述和荟萃分析首选报告项目（PRISMA）声明进行，之前已在 PROSPERO 注册，注册号为 CRD42024547773：这项荟萃分析最终纳入了 15 项试验，共涉及 4505 名患者。BcQT短期疗程的根除率低于14天疗程（RR 0.96，95% CI 0.93-0.99）。不过，10 天疗程的根除率与 14 天疗程相当（RR 0.98，95% CI 0.95-1.00）。抗生素组合的分组分析表明，四环素和甲硝唑组合在 7 天与 14 天 BcQT 中的幽门螺杆菌根除率相似（RR 0.93，95% CI 0.84-1.02）。在钾竞争性酸阻滞剂亚组中，无论是整体评估短期治疗组，还是分别评估 7 天和 10 天亚组，14 天组和短期治疗组的根除率仍然相似。此外，BcQT短期疗程的不良反应和依从性与14天疗程相当：结论：BcQT 10 天疗程可能是最佳治疗时间。结论：10 天疗程的 BcQT 可能是最佳治疗时间，但在选择抗生素组合时应考虑幽门螺杆菌的区域抗生素耐药模式，因为耐药率较低的抗生素组合更有效：试验注册：PROSPERO 编号试验注册：PROSPERO 编号：CRD42024547773。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Helicobacter 医学-微生物学

CiteScore

8.40

自引率

9.10%

发文量

审稿时长

2 months

期刊介绍： Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.