Fluoroquinolone Sequential Therapy for Helicobacter pylori: A Meta-analysis

• Published in: Pharmacotherapy 2015-08, Vol.35 (8), p.719-730
• Main Authors: Kale-Pradhan, Pramodini B., Mihaescu, Anela, Wilhelm, Sheila M.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Drug Therapy, Combination; eradication; fluoroquinolone; Fluoroquinolones - adverse effects; Fluoroquinolones - therapeutic use; Helicobacter Infections - drug therapy; Helicobacter pylori; Humans; meta-analysis; Randomized Controlled Trials as Topic; sequential therapy
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1002/phar.1614

Study Objective As resistance of Helicobacter pylori to standard first‐line therapy is increasing globally, alternative treatment regimens, such as a fluoroquinolone‐based sequential regimen, have been explored. The objective of this meta‐analysis was to compare the efficacy of fluoroquinolone‐based sequential therapy with standard first‐line treatment for H. pylori infection. Design Meta‐analysis of six randomized controlled trials. Patients A total of 738 H. pylori–infected, treatment‐naive adults who received fluoroquinolone‐based sequential therapy (5–7 days of a proton pump inhibitor [PPI] and amoxicillin therapy followed by 5–7 days of a PPI, a fluoroquinolone, and metronidazole or tinidazole or furazolidone therapy) and 733 H. pylori–infected, treatment‐naive adults who received guideline‐recommended, first‐line therapy with standard triple therapy (7–14 days of a PPI plus amoxicillin and clarithromycin) or standard sequential therapy (5 days of a PPI plus amoxicillin, followed by an additional 5 days of triple therapy consisting of a PPI, clarithromycin, and metronidazole or tinidazole). Measurements and Main Results A systematic literature search of the MEDLINE, PubMed, and Cochrane Central Register of Controlled Trials databases (from inception through January 2015) was conducted to identify randomized controlled trials that compared fluoroquinolone‐based sequential therapy with guideline‐recommended, first‐line treatment regimens in H. pylori–infected, treatment‐naive adults. All selected trials confirmed H. pylori infection prior to treatment as well as post‐treatment eradication. A meta‐analysis was performed by using Review Manager 5.2. Treatment effect was determined with a random‐effects model by using the Mantel–Haenszel method and was reported as a risk ratio (RR) with 95% confidence interval (CI). In the six randomized controlled trials that met the inclusion criteria, 648 (87.8%) of 738 patients receiving fluoroquinolone‐based sequential therapy and 521 (71.1%) of 733 patients receiving standard regimens achieved eradication (RR 1.21, 95% CI 1.09–1.35). The frequencies of adverse effects that were reported in three of the trials were comparable for all treatments (RR 0.99, 95% CI 0.76–1.29). In addition, no statistically significant difference was noted in the number of patients who experienced adverse effects that prompted discontinuation of therapy (RR 1.03, 95% CI 0.34–3.09). The H. pylori eradication rate appeared similar among the