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Ten-day and PCAB-based regimens achieve relatively higher H. pylori eradication rates, whereas sequential and multi-antibiotic regimens are associated with more adverse events.
With antibiotic resistance continuing to compromise eradication of Helicobacter pylori (H. pylori) worldwide, selecting the most effective treatment regimen remains a major clinical challenge. To provide a clearer comparison of available strategies, investigators analyzed evidence from randomized and observational studies evaluating the efficacy and safety of commonly used eradication regimens.
The meta-analysis included 57 studies for efficacy assessment involving 19,941 participants and 54 studies for safety evaluation. The analysis demonstrated notable differences in eradication outcomes across treatment strategies, as shown in Table 1.
Beyond these findings, regimens containing three antibiotics (86.9%) and nitroimidazoles (84.8%) demonstrated higher eradication rates. Safety analyses further showed higher adverse event rates with three-antibiotic regimens (52.6%), nitroimidazole-containing regimens (37.1%), and macrolide-containing regimens (29.0%).
To sum up, H. pylori eradication is not simply a race to achieve the highest percentage. A regimen that delivers strong bacterial clearance but causes frequent adverse events may affect adherence and ultimately undermine treatment success. Conversely, a better-tolerated regimen may be less potent in some settings. The optimal strategy therefore needs to balance efficacy, tolerability and the clinical context, particularly as antibiotic resistance continues to complicate H. pylori management.
Frontiers in Medicine (Lausanne)
Efficacy and safety of antibiotic regimens for Helicobacter pylori eradication: a systematic review and meta-analysis
Yinhua Liao et al.
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