Should Metronidazole Be Included in Second-Line Treatment After Standard Triple Therapy for Helicobacter pylori?: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter Pub Date : 2025-01-27 DOI:10.1111/hel.70010

Hideki Mori, Toshihiro Nishizawa, Kohei Morioka, Motohiko Kato, Takanori Kanai

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Abstract

Background and Aim

Although standard triple therapy remains the first-line eradication treatment for H. pylori worldwide, it is unclear whether metronidazole should be included empirically in second-line eradication treatments. The aim of this study was to compare the efficacy of metronidazole-containing regimens with that of metronidazole-free regimens after failure of first-line eradication using standard triple therapy.

Methods

PubMed, the Cochrane Library, and the Igaku-Chuo-Zasshi database were searched to identify RCTs eligible for inclusion in this systematic review and meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Results

Thirteen eligible RCTs were included, with a total of 2039 patients assigned to metronidazole-containing (975 patients) or metronidazole-free (1064 patients) regimens. Metronidazole-containing regimens had significantly lower eradication failure rates than regimens without metronidazole (OR 0.55; 95% CI, 0.39–0.78). Subgroup analysis based on the regional risk of metronidazole resistance demonstrated that metronidazole-containing regimens had lower eradication failure rates not only in low-risk regions but also in high-risk regions (OR, 0.29; 95% CI, 0.11–0.74 and OR, 0.66; 95% CI, 0.49–0.91, respectively).

Conclusion

After failure of standard triple therapy, secondary eradication treatment regimens containing metronidazole demonstrate higher eradication rates than those without metronidazole.

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幽门螺杆菌标准三联治疗后，甲硝唑是否应纳入二线治疗？随机对照试验的系统回顾和荟萃分析。

背景和目的：虽然标准三联疗法仍然是世界范围内根除幽门螺杆菌的一线治疗方法，但目前尚不清楚甲硝唑是否应该纳入二线根除治疗。本研究的目的是比较使用标准三联疗法在一线根除失败后，含甲硝唑方案与不含甲硝唑方案的疗效。方法：检索PubMed、Cochrane图书馆和Igaku-Chuo-Zasshi数据库，以确定符合纳入本系统评价和荟萃分析的rct。计算95%置信区间（ci）的比值比（ORs）。结果：纳入13项符合条件的随机对照试验，共2039例患者被分配到含甲硝唑（975例）或不含甲硝唑（1064例）方案。含甲硝唑方案的根除失败率显著低于不含甲硝唑方案(OR 0.55；95% ci, 0.39-0.78)。基于甲硝唑耐药区域风险的亚组分析表明，含甲硝唑方案不仅在低风险地区，而且在高风险地区根除失败率更低(OR, 0.29；95% CI, 0.11-0.74， OR, 0.66；95% CI分别为0.49-0.91)。结论：在标准三联治疗失败后，含甲硝唑的二次根除治疗方案的根除率高于不含甲硝唑的治疗方案。

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.