Pooled analysis of anti-Helicobacter pylori treatment regimens.

BACKGROUND: The human pathogen Helicobacter pylori and its association with peptic ulcer has dramatically changed the therapeutic approach to patients with this disease. Successful treatment of the infection has consistently been shown to prevent ulcer recurrence. Published data on therapeutic options are sometimes confusing since only few studies have similar design, drug combinations, dosage, dosing, formulation, patient material, and size. A formal meta-analysis is therefore of limited value.
METHOD: Data on anti-H. pylori therapies from a large number of publications are pooled into a few groups based on the combination of drugs, regardless of dosage, duration, etc., of the therapy. A mean success rate is calculated for all studies with subanalysis with regard to study design, size, doses and duration.
RESULTS: Triple combinations are needed to achieve a success rate of more than 80%. Bismuth/tetracycline based triple therapy gives 82% success rate (range 43-100%) compared to 85% and 87% success rate (range 72-100% and 43-100%) achieved with omeprazole/clarithromycin based triples respectively.
CONCLUSION: Omeprazole/clarithromycin based triple regimens are the most effective anti-H. pylori therapeutic strategies, slightly superior to bismuth triple regimens.