Is antimicrobial susceptibility testing necessary before first-line treatment for Helicobacter pylori infection? - Meta-analysis of randomized controlled trials

Yuan Wenzhen, Li Yumin, Guan Quanlin, Yang Kehu, Jiang Lei, Wang Donghai, Yang Lijuan

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background With the wide use of antibiotics, antibiotic-resistant Helicobacter pylori strains are becoming increasingly prevalent. It has been hypothesized that culture-guided therapy might help to increase treatment success. But the effects and the costs still remain controversial. Aims To systematically review the efficacy and the cost of culture-guided triple therapy, compared to standard triple regimen for first-line treatment of Helicobacter pylori infection. Methods A search of the Cochrane Library, PubMed, EMBASE, Science Citation Index Expanded and CBM was performed. Randomized controlled trials comparing culture-guided triple therapy to standard triple therapy in the first-line treatment of Helicobacter pylori infection were selected for meta-analysis. Relative risk was used as a measure of the effect of two regimens mentioned above with a fixed-effects model using the methods of DerSimonian and Laird. Results Five randomized controlled trials totaling 701 patients were included. The meta-analysis showed that culture-guided triple therapy was superior referring to a higher eradication rate from intention-to-treat analyses (RR, 0.84; 95% CI,0.77, 0.90; p<0.00001) and a lower overall cost. Conclusion Culture-guided triple therapy was more effective than standard triple therapy for first-line treatment of Helicobacter pylori infection. Based on the only paper focused on the overall cost, the cultureguided triple therapy was also more cost saving. Antimicrobial susceptibility testing is necessary before firstline treatment for Helicobacter pylori infection.

Original languageEnglish (US)
Pages (from-to)1103-1109
Number of pages7
JournalInternal Medicine
Volume49
Issue number12
DOIs
StatePublished - 2010

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Helicobacter Infections
Helicobacter pylori
Meta-Analysis
Randomized Controlled Trials
Therapeutics
Costs and Cost Analysis
Anti-Bacterial Agents
Intention to Treat Analysis
PubMed
Libraries

Keywords

  • Culture-guided triple therapy
  • First-line treatment
  • Helicobacter pylori
  • Meta-analysis
  • Overall cost
  • Standard triple therapy

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Is antimicrobial susceptibility testing necessary before first-line treatment for Helicobacter pylori infection? - Meta-analysis of randomized controlled trials. / Wenzhen, Yuan; Yumin, Li; Quanlin, Guan; Kehu, Yang; Lei, Jiang; Donghai, Wang; Lijuan, Yang.

In: Internal Medicine, Vol. 49, No. 12, 2010, p. 1103-1109.

Research output: Contribution to journalArticle

Wenzhen, Yuan ; Yumin, Li ; Quanlin, Guan ; Kehu, Yang ; Lei, Jiang ; Donghai, Wang ; Lijuan, Yang. / Is antimicrobial susceptibility testing necessary before first-line treatment for Helicobacter pylori infection? - Meta-analysis of randomized controlled trials. In: Internal Medicine. 2010 ; Vol. 49, No. 12. pp. 1103-1109.
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abstract = "Background With the wide use of antibiotics, antibiotic-resistant Helicobacter pylori strains are becoming increasingly prevalent. It has been hypothesized that culture-guided therapy might help to increase treatment success. But the effects and the costs still remain controversial. Aims To systematically review the efficacy and the cost of culture-guided triple therapy, compared to standard triple regimen for first-line treatment of Helicobacter pylori infection. Methods A search of the Cochrane Library, PubMed, EMBASE, Science Citation Index Expanded and CBM was performed. Randomized controlled trials comparing culture-guided triple therapy to standard triple therapy in the first-line treatment of Helicobacter pylori infection were selected for meta-analysis. Relative risk was used as a measure of the effect of two regimens mentioned above with a fixed-effects model using the methods of DerSimonian and Laird. Results Five randomized controlled trials totaling 701 patients were included. The meta-analysis showed that culture-guided triple therapy was superior referring to a higher eradication rate from intention-to-treat analyses (RR, 0.84; 95{\%} CI,0.77, 0.90; p<0.00001) and a lower overall cost. Conclusion Culture-guided triple therapy was more effective than standard triple therapy for first-line treatment of Helicobacter pylori infection. Based on the only paper focused on the overall cost, the cultureguided triple therapy was also more cost saving. Antimicrobial susceptibility testing is necessary before firstline treatment for Helicobacter pylori infection.",
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