Levofloxacin-based triple therapy versus bismuth-based quadruple therapy for persistent Helicobacter pylori infection:: A meta-analysis
Levofloxacin-based triple therapy versus bismuth-based quadruple therapy for persistent Helicobacter pylori infection:: A meta-analysis
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DOI：
10.1111/j.1572-0241.2006.00637.x
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发表时间：
2006-03-01
影响因子：
9.8
通讯作者：
Chey, WD
中科院分区：
文献类型：
--
作者：
Saad, RJ;Schoenfeld, P;Chey, WD
背景技术背景：以左氧氟沙星为基础的三联疗法已被建议作为铋剂为基础的四联疗法治疗持续性幽门螺杆菌（H。pylori）感染。检索PUBMED、EMBASE、EBM Review数据库和最近消化疾病周、联合欧洲胃肠病学周和欧洲螺杆菌研究组会议的摘要。选择比较以左氧氟沙星为基础的三联挽救治疗（左氧氟沙星+阿莫西林+ PPI）与以铋剂为基础的四联挽救治疗（铋剂+四环素+甲硝唑+ PPI）的随机对照试验（RCT）进行荟萃分析。此外，将所有评价这种基于左氧氟沙星的三联疗法作为挽救治疗的前瞻性试验汇总，以分析最佳左氧氟沙星治疗持续时间和剂量。所有选定的试验证实了先前的治疗失败和补救治疗后根除。结果：四项随机对照试验比较了10天的方案，左氧氟沙星为基础的三联疗法，以7天铋为基础的四联疗法（n = 391例）。以左氧氟沙星为基础的三联疗法上级优于四联疗法（RR = 1.41 [95% CI：1.25-1.59]）。以左氧氟沙星为基础的三联疗法比四联疗法耐受性更好，副作用发生率更低（RR = 0.51 [95% CI：0.34-0.75]），导致停药的副作用发生率更低（RR = 0.30 [95% CI：0.10-0.89]）。11项评价基于左氧氟沙星的三联疗法的试验（n = 547例患者）显示，10天方案与7天方案的根除率更高（87% [95% CI：82%-92%] vs 68% [95% CI：62%-74%]），但8项试验（n = 477例患者）显示，500 mg每日一次与250 mg b.i.d.结论：10天疗程的左氧氟沙星三联疗法比7天铋剂三联疗法治疗持续性H.幽门感染
BACKGROUND: Levofloxacin-based triple therapy has been suggested as an alternative salvage therapy to bismuth-based quadruple therapy for persistent Helicobacter pylori (H. pylori) infection.METHODS: A search of PUBMED, EMBASE, EBM Review databases and abstracts from recent Digestive Disease Week, United European Gastroenterology Week, and European Helicobacter Study Group conferences was performed. Randomized controlled trials (RCTs) comparing levofloxacin-based triple salvage therapy (levofloxacin + amoxicillin + PPI) to bismuth-based quadruple salvage therapy (bismuth + tetracycline + metronidazole + PPI) were selected for meta-analysis. Additionally, all prospective trials evaluating this levofloxacin-based triple therapy as salvage therapy were pooled to analyze optimal levofloxacin treatment duration and dosing. All selected trials confirmed prior treatment failure and post-salvage treatment eradication.RESULTS: Four RCTs compared a 10-day regimen of levofloxacin-based triple therapy to 7-day bismuth-based quadruple therapy (n = 391 patients). Levofloxacin-based triple therapy was superior to quadruple therapy (RR = 1.41 [95% CI: 1.25-1.59]). Levofloxacin-based triple therapy was better tolerated than quadruple therapy with a lower incidence of side effects (RR = 0.51 [95% CI: 0.34-0.75]) and side effects prompting discontinuation of therapy (RR = 0.30 [95% CI: 0.10-0.89]). Eleven trials (n = 547 patients) evaluating levofloxacin-based triple therapy demonstrated higher eradication rates with 10-day versus 7-day regimen (87% [95% CI: 82%-92%] vs 68% [95% CI: 62%-74%]) yet eight trials (n = 477 patients) demonstrated no difference with 500 mg daily versus 250 mg b.i.d. dosing of levofloxacin (81% [95% CI: 78%-89%] vs 84% [95% CI: 66%-97%]).CONCLUSIONS: A 10-day course levofloxacin triple therapy is more effective and better tolerated than 7-day bismuth-based quadruple therapy in the treatment of persistent H. pylori infection.