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De Francesco V, Zullo A, Manta R, et al. Helicobacter pylori eradication following first-line treatment failure in Europe: What, how and when chose among different standard regimens? A systematic review. Eur J Gastroenterol Hepatol. 2021;doi: 10.1097/MEG.0000000000002100.
De Francesco, V., Zullo, A., Manta, R., Gatta, L., Fiorini, G., Saracino, I. M., & Vaira, D. (2021). Helicobacter pylori eradication following first-line treatment failure in Europe: What, how and when chose among different standard regimens? A systematic review. European journal of gastroenterology & hepatology, . https://doi.org/10.1097/MEG.0000000000002100
De Francesco, Vincenzo, et al. "Helicobacter pylori eradication following first-line treatment failure in Europe: What, how and when chose among different standard regimens? A systematic review." European journal of gastroenterology & hepatology vol. (2021). doi: https://doi.org/10.1097/MEG.0000000000002100
De Francesco V, Zullo A, Manta R, Gatta L, Fiorini G, Saracino IM, Vaira D. Helicobacter pylori eradication following first-line treatment failure in Europe: What, how and when chose among different standard regimens? A systematic review. Eur J Gastroenterol Hepatol. 2021 Mar 19; doi: 10.1097/MEG.0000000000002100. Epub 2021 Mar 19. PMID: 33741798.
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Eur J Gastroenterol Hepatol. 2021 Mar 19; doi: 10.1097/MEG.0000000000002100. Epub 2021 Mar 19.

Helicobacter pylori eradication following first-line treatment failure in Europe: What, how and when chose among different standard regimens? A systematic review.

European journal of gastroenterology & hepatology

Vincenzo De Francesco, Angelo Zullo, Raffaele Manta, Luigi Gatta, Giulia Fiorini, Ilaria M Saracino, Dino Vaira

Affiliations

  1. Gastroenterology Unit, 'Riuniti' Hospital, Foggia Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome Gastroenterology and Digestive Endoscopy, 'Generale' Hospital', Perugia Gastroenterogy and Endoscopy Unit, Versilia Hospital, Lido di Camaiore Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy.

PMID: 33741798 DOI: 10.1097/MEG.0000000000002100

Abstract

Cure rate following standard first-line regimens for Helicobacter pylori eradication is decreasing so several patients require two or more treatments. Antibiotic susceptibility-based therapy, advised in current guidelines, is largely impracticable in clinical practice. Some 'standard' regimens (triple therapies based on either levofloxacin or rifabutin, bismuth-based quadruple therapies, sequential, concomitant and hybrid therapies) were empirically used as rescue therapies. We performed a systematic review on recent studies carried out in European countries dealing with these regimens. A total of 24 studies, with 3804 patients, were identified. As second-line therapy, Pylera (89.2%) and sequential therapy (92.5%) achieved significantly higher cure rates as compared to all the other regimens. As third-line therapy, levofloxacin-based therapy (84.1%) and Pylera (83.6%) achieved similarly high cure rates, whereas standard, bismuth-based quadruple therapy (64.1%) achieved the lowest. As a rescue therapy, the success rate was close to 75% following all therapies used, with data on rifabutin-based regimen consolidated in the larger sample size. Overall, levofloxacin-amoxicillin triple therapy achieved higher eradication rates when the 14- rather than 10-day regimen was used (87.1 vs. 72.2%; P = 0.003). Among bismuth-based therapies, Pylera achieved a significantly higher eradication rate than standard quadruple therapy (88 vs. 67%; P < 0.0001). These data suggest that a wise 'therapeutic package' following first-line therapy could be Pylera, levofloxacin- and rifabutin-based therapy, as long as Pylera therapy was not used as a first-line regimen and levofloxacin-based regimen was administered for 14 days.

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