Table 4.
Characteristics of systematic reviews comparing triple therapy versus bismuth-based therapy (n = 9)
| Author, Year, country | Last search date | Disease | Countries of included RCTsf | Triple therapy | Bismuth-based Quadruple therapy | No. of studies in MA | No. of patients in MA | Eradication rates by ITT | Eradication rates odds ratio (95 % CI) by ITTd | Quality assessmente |
|---|---|---|---|---|---|---|---|---|---|---|
| Gene et al. 2003 Spain [38] | Aug 2002 | HP infection; naïve to therapy; PUD/NUD | Spain (2), US/Canada, unknown | PPI (ome/panto) + clarithromycin + amoxicillin | Bismuth + PPI(ome/panto) + tetracycline + metronidazole | 4 | 981 | 78 % vs. 81 % | 0.83 (0.61–1.14)a | 0 |
| Gisbert et al. 2005 Spain [27] | Sep 2004 | HP infection; NUD+/−PUD; previous treatment failures | Croatia, Spain (6), Belgium, Italy (4), Greece, China | PPI (ome/lanso/panto) + clarithromycin + amoxicillin/nitroimidazole | RBC + clarithromycin + amoxicillin | 14 | 2205 | 78 % vs. 79 % | Bismuth vs. triple 1.11 (0.88–1.40) | + |
| Croatia, Italy (6), Spain, Norway, Unknown (2), The Netherlands, China | PPI (ome/lanso/panto/rabe) + clarithromycin + amoxicillin/nitroimidazole | RBC + clarithromycin + nitroimidazole | 13 | 1777 | 80 % vs. 87 % | Bismuth vs. triple 1.65 (1.15–2.37) | ||||
| Taiwan, China, UK | PPI (ome) + clarithromycin + amoxicillin/nitroimidazole | RBC + nitroimidazole + amoxicillin | 3 | 451 | 75 % vs. 73 % | Bismuth vs. triple 0.92 (0.60–1.41) | ||||
| Gisbert et al. 2006 Spain [28] | Jul 2005 | HP infection; Previous treatment failures | Italy (5), China, Spain, unknown | Levofloxacin-containing: levofloxacin + PPI(panto/rabe/esome/ome) + amoxicillin/rifabutin | Bismuth + PPI(panto/rabe/ome) + tetracycline + metronidazole; or RBC+ tetracycline + metronidazole | 8 | 996 | 81 % vs. 70 % | 1.80 (0.9–3.5) | 0 |
| Not reported | Levofloxacin + amoxicillin + PPI(panto/rabe/esome/ome) | Bismuth + PPI(panto/rabe/ome) + tetracycline + metronidazole; or RBC+ tetracycline + metronidazole | not specified | Not specified | Not reported | 1.7 (0.71–4.0) | ||||
| Saad et al. 2006 US [29] | Apr 2005 | HP infection; failed prior course(s) of standard triple therapy | Italy (5), China | Levofloxacin-containing : levofloxacin+ +amoxicillin+ | Bismuth − + metronidazole + tetracycline+ | 6 | 854 | 87 % vs. 60 % | 1.18 (1.08–1.29)b | 0 |
| + same PPI (ome/esome/rabe/panto) | ||||||||||
| Li et al. 2010 China [30] | 1981-Mar 2009 (Published date) | HP infection; previous treatment failures | Germany (2), Ireland | Clarithromycin-containing: clarithromycin + amoxicillin+ | Bismuth+ +metronidazole + tetracycline+ | 3 | 411 | 46.5 % vs. 61.9 % | 0.53 (0.35–0.80) | 0 |
| + same PPI (ome/not specified) | ||||||||||
| Korea (2), Croatia | Moxifloxacin-containing: moxifloxacin + amoxicillin/metronidazole+ | Bismuth + metronidazole + tetracycline+ | 3 | 437 | Not reported | 1.78 (0.98–3.22) | ||||
| +PPI(esome/ome) | ||||||||||
| Taiwan, Korea, China (5), Italy (2) | Levofloxacin-containing: levofloxacin + amoxicillin/rifabutin+ | Bismuth + metronidazole + tetracycline+ | 9 | 928 | Not reported | 1.43 (0.82–2.51) | ||||
| + same PPI(esome/panto/lanso/rabe) | ||||||||||
| Luther et al. 2010 US [50] | 1990–2008 (Published date) | HP infection | Spain (2), Greece, Australia/New Zealand, India, US/Canada, Korea, Turkey, UK | Clarithromycin-containing: clarithromycin + amoxicillin+ | Bismuth + metronidazole + tetracycline + | 9 | 1679 | 77.0 % vs. 78.3 % | Bismuth vs. triple 1.00 (0.94–1.07b | 0 |
| +PPI (ome/panto/lanso/not specified) | ||||||||||
| Wu et al. 2011 China [31] | Dec 2010 | HP infection; previous treatment failures | China (4), Korea (2), Croatia | Moxifloxacin-containing: Moxifloxacin + + amoxicillin/metronidazole+ | Bismuth + metronidazole/furazolidone + tetracycline/amoxicillin/clarithromycin+ | 7 | 787 | 74.9 % vs. 61.4 % | 1.89 (1.38–2.58) | ++ |
| + PPI (esome/ome/rabe) | ||||||||||
| Di Caro et al. 2012 UK [32] | Oct 2010 | HP infection; previous treatment failures | Italy (4), Spain (2), China (4), Korea (2), Taiwan, Unknown | Levofloxacin + amoxicillin-containing: levofloxacin + amoxicillin + PPI(panto/rabe/esome/ome/lanso) | Bismuth quadruple therapy (not specified) | 14 | 1331 | 76.5 % vs. 67.4 % | 1.59 (0.98–2.58) | 0 |
| Venerito et al. 2013 Germany [39] | Nov 2011 | HP infection; naïve to therapy; PUD/NUD/others | Spain (2), Australia/New Zealand, Greece, US/Canada, India, Korea, Turkey (2), UK, China, multi European countries | Clarithromycin-containing: clarithromycin + amoxicillin+ | Bismuth + tetracycline + metronidazole+ | 12 | 2467 | 68.9 % vs. 77.6 % | Bismuth vs. triple 0.06 (−0.01–0.13)c | + |
| +PPI(ome/panto/lanso/not specified) | ||||||||||
HP H.pylori, PPI proton pump inhibitor, esome esomeprazole, lanso lansoprazole, ome omeprazole, panto pantoprazole, rabe rabeprazole, PUD peptic ulcer disease, NUD non-ulcer dyspepsia, MA meta-analysis, ITT intention to treat, CI confidence interval, RCT randomized controlled trials, RBC ranitidine bismuth citrate
a Peto OR is reported here
b Relative risk is reported here
c Risk difference is reported here
d OR > 1 indicates that triple therapy is associated with greater effectiveness than bismuth-based therapy and vice versa. When “Bismuth vs. triple” is specified in the form, OR > 1 indicates bismuth-based therapy is associated with greater effectiveness than triple therapy and vice versa
e Quality assessment: high quality (++): majority of criteria met, little or no risk of bias and results unlikely to be changed by further research. Acceptable (+): most criteria met, some flaws in the study with an associated risk of bias and conclusions may change in the light of further studies. Low quality (0): either most criteria not met or significant flaws relating to key aspects of study design, and conclusions likely to change in the light of further studies
f Countries of included RCTs: the number in the bracket represents the number of trials from the same country if more than one trials exist