AUTHOR=Ouyang Yaobin , Zhang Wenjing , He Chen , Zhu Yin , Lu Nonghua , Hu Yi 

TITLE=Susceptibility-Guided Therapy vs. Bismuth-Containing Quadruple Therapy as the First-Line Treatment for Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

JOURNAL=Frontiers in Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.844915

DOI=10.3389/fmed.2022.844915

ISSN=2296-858X

ABSTRACT=<sec><title>Background</title><p>The increased antibiotic resistance of <italic>Helicobacter pylori</italic> (<italic>H. pylori</italic>) has led to the decreased efficacy of <italic>H. pylori</italic> regimens.</p></sec><sec><title>Aim</title><p>To evaluate the efficacy, safety, and compliance of susceptibility-guided therapy (SGT) vs. bismuth-containing quadruple therapy (BQT) as the first-line treatment for <italic>H. pylori</italic> infection.</p></sec><sec><title>Materials and Methods</title><p>This meta-analysis was performed in accordance with the PRISMA 2009 guidelines. A systematic search in PubMed, Embase, and Cochrane databases was conducted using the combination of “<italic>H. pylori</italic> or <italic>H. pylori</italic> or <italic>Hp</italic>,” “bismuth quadruple,” and “tailored eradication OR tailored therapy OR susceptibility-guided therapy OR personalized therapy OR antibiotic susceptibility testing.”</p></sec><sec><title>Results</title><p>Five studies with 2,110 <italic>H. pylori-</italic>infected patients were enrolled. The pooled eradication rates of SGT and BQT were 86 vs. 78% (<italic>p</italic> &lt; 0.05) and 92 vs. 86% (<italic>p</italic> &gt; 0.05) by intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. SGT has a significantly superior efficacy than BQT [pooled risk ratio (RR) = 1.14, <italic>p</italic> &lt; 0.05] in a subgroup of cultures with the susceptibility test. The pooled side effect rate was 20% in SGT and 22% in BQT, which showed no significant difference (<italic>p</italic> &gt; 0.05). The compliances of SGT and BQT were 95 and 92%, respectively.</p></sec><sec><title>Conclusion</title><p>Compared with BQT, SGT showed a higher efficacy and similar safety as the first-line treatment of <italic>H. pylori</italic> infection in areas with high antibiotic resistance. The decision-making of first-line regimens for <italic>H. pylori</italic> infection should depend on the availability and cost-effectiveness of susceptibility tests and bismuth in local areas.</p></sec>