BACKGROUND: Low success rates with triple therapy for Helicobacter pylori infections have prompted search for alternatives. In one, a proton-pump inhibitor (PPI) and amoxicillin was followed by the PPI plus clarithromycin and a nitroimidazole (sequential therapy); in another, these four drugs were given concomitantly (concomitant therapy). AIM: To compare concomitant therapy with standard triple therapy for H. pylori infection. METHODS: By searching PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and abstracts of major gastrointestinal meeting, two independent reviewers systemically identified randomized controlled trials (RCT) comparing concomitant quadruple to standard triple therapies as well as studies reporting eradication rates of concomitant quadruple therapy in treatment of H. pylori. Pooled eradication rates and odds ratios (OR) with 95% confidence intervals (CI) were calculated, and univariable metaregression analysis for all extracted variables was conducted. RESULTS: We identified nine studies (10 treatment arms) including five qualifying RCTs (576 subjects) comparing concomitant (293 subjects, duration 3 to 5 days) and triple therapy (283 subjects, duration 5 to 10 days) and four other studies evaluating concomitant therapy (478 subjects, duration 3 to 7 days). Pooled estimates of the five RCTs showed superiority of concomitant therapy over triple therapy; with intention-to-treat) pooled OR of 2.86 (95% CI: 1.73-4.73) and per-protocol (PP) pooled OR of 3.52 (95% CI: 1.95-6.38). Considering all 10 treatment arms, the ITT eradication rate was 89.7% (95% CI: 86.8-92.1%) and PP was 92.9% (95% CI: 90.2-94.8%). CONCLUSION: Concomitant therapy appears to be an effective alternative to triple therapy and is less complex than sequential therapy.
BACKGROUND: Low success rates with triple therapy for Helicobacter pyloriinfections have prompted search for alternatives. In one, a proton-pump inhibitor (PPI) and amoxicillin was followed by the PPI plus clarithromycin and a nitroimidazole (sequential therapy); in another, these four drugs were given concomitantly (concomitant therapy). AIM: To compare concomitant therapy with standard triple therapy for H. pyloriinfection. METHODS: By searching PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and abstracts of major gastrointestinal meeting, two independent reviewers systemically identified randomized controlled trials (RCT) comparing concomitant quadruple to standard triple therapies as well as studies reporting eradication rates of concomitant quadruple therapy in treatment of H. pylori. Pooled eradication rates and odds ratios (OR) with 95% confidence intervals (CI) were calculated, and univariable metaregression analysis for all extracted variables was conducted. RESULTS: We identified nine studies (10 treatment arms) including five qualifying RCTs (576 subjects) comparing concomitant (293 subjects, duration 3 to 5 days) and triple therapy (283 subjects, duration 5 to 10 days) and four other studies evaluating concomitant therapy (478 subjects, duration 3 to 7 days). Pooled estimates of the five RCTs showed superiority of concomitant therapy over triple therapy; with intention-to-treat) pooled OR of 2.86 (95% CI: 1.73-4.73) and per-protocol (PP) pooled OR of 3.52 (95% CI: 1.95-6.38). Considering all 10 treatment arms, the ITT eradication rate was 89.7% (95% CI: 86.8-92.1%) and PP was 92.9% (95% CI: 90.2-94.8%). CONCLUSION: Concomitant therapy appears to be an effective alternative to triple therapy and is less complex than sequential therapy.
Authors: P M Neville; S Everett; H Langworthy; D Tompkins; N P Mapstone; A T Axon; P Moayyedi Journal: Aliment Pharmacol Ther Date: 1999-04 Impact factor: 8.171
Authors: M Okada; H Nishimura; M Kawashima; N Okabe; K Maeda; M Seo; K Ohkuma; T Takata Journal: Aliment Pharmacol Ther Date: 1999-06 Impact factor: 8.171
Authors: M Okada; K Oki; T Shirotani; M Seo; N Okabe; K Maeda; H Nishimura; K Ohkuma; K Oda Journal: J Gastroenterol Date: 1998-10 Impact factor: 7.527
Authors: Ala I Sharara; Fayez S Sarkis; Mustapha M El-Halabi; Ahmad Malli; Nabil M Mansour; Cecilio Azar; Mohamad A Eloubeidi; Fadi H Mourad; Kassem Barada; Ismail Sukkarieh Journal: United European Gastroenterol J Date: 2014-06 Impact factor: 4.623
Authors: C Krystallis; D Kamberoglou; D Pistiolas; C Anifanti; A Koutsoumbas; V Doulgeroglou; V Tzias Journal: Dig Dis Sci Date: 2010-12 Impact factor: 3.199
Authors: Antonio Rollan; Juan Pablo Arab; M Constanza Camargo; Roberto Candia; Paul Harris; Catterina Ferreccio; Charles S Rabkin; Juan Cristóbal Gana; Pablo Cortés; Rolando Herrero; Luisa Durán; Apolinaria García; Claudio Toledo; Alberto Espino; Nicole Lustig; Alberto Sarfatis; Catalina Figueroa; Javier Torres; Arnoldo Riquelme Journal: World J Gastroenterol Date: 2014-08-21 Impact factor: 5.742
Authors: Javier P Gisbert; Xavier Calvet; Juan Ferrándiz; Juan Mascort; Pablo Alonso-Coello; Mercè Marzo Journal: Aten Primaria Date: 2012-10-01 Impact factor: 1.137