J Korean Med Sci.  2014 May;29(5):704-713. 10.3346/jkms.2014.29.5.704.

Meta-Analysis of First-Line Triple Therapy for Helicobacter pylori Eradication in Korea: Is It Time to Change?

• Gong EJ
• Yun SC
• Jung HY
• Lim H
• Choi KS
• Ahn JY
• Lee JH
• Kim DH
• Choi KD
• Song HJ
• Lee GH
• Kim JH

• KMID: 1786114
• DOI: http://doi.org/10.3346/jkms.2014.29.5.704

Abstract

Proton pump inhibitor (PPI)-based triple therapy consisting of PPI, amoxicillin, and clarithromycin, is the recommended first-line treatment for Helicobacter pylori infection. However, the eradication rate of triple therapy has declined over the past few decades. We analyzed the eradication rate and adverse events of triple therapy to evaluate current practices in Korea. A comprehensive literature search was performed up to August 2013 of 104 relevant studies comprising 42,124 patients. The overall eradication rate was 74.6% (95% confidence interval [CI], 72.1%-77.2%) by intention-to-treat analysis and 82.0% (95% CI, 80.8%-83.2%) by per-protocol analysis. The eradication rate decreased significantly from 1998 to 2013 (P < 0.001 for both intention-to-treat and per-protocol analyses). Adverse events were reported in 41 studies with 8,018 subjects with an overall incidence rate of 20.4% (95% CI, 19.6%-21.3%). The available data suggest that the effectiveness of standard triple therapy for H. pylori eradication has decreased to an unacceptable level. A novel therapeutic strategy is warranted to improve the effectiveness of first-line treatment for H. pylori infection in Korea.

Keyword

Helicobacter pylori; Eradication; Triple Therapy

MeSH Terms

Alkylating Agents/therapeutic use
Amoxicillin/therapeutic use
Anti-Bacterial Agents/therapeutic use
Anti-Ulcer Agents/therapeutic use
Clarithromycin/therapeutic use
*Communicable Disease Control
Cytochrome P-450 CYP3A Inhibitors/therapeutic use
*Disease Eradication
*Drug Resistance, Bacterial
Drug Therapy, Combination
Gastritis/microbiology/pathology
Helicobacter Infections/*drug therapy
Helicobacter pylori
Humans
Metronidazole/therapeutic use
Proton Pump Inhibitors/*therapeutic use
Republic of Korea
Tinidazole/therapeutic use
Alkylating Agents
Amoxicillin
Anti-Bacterial Agents
Anti-Ulcer Agents
Clarithromycin
Cytochrome P-450 CYP3A Inhibitors
Metronidazole
Proton Pump Inhibitors
Tinidazole