Meta-Analysis
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2018; 24(29): 3302-3312
Published online Aug 7, 2018. doi: 10.3748/wjg.v24.i29.3302
Fourth-generation quinolones in the treatment of Helicobacter pylori infection: A meta-analysis
Ying An, Ya Wang, Shuang Wu, You-Hua Wang, Xing Qian, Zhen Li, Ying-Jun Fu, Yong Xie
Ying An, Ya Wang, Shuang Wu, You-Hua Wang, Xing Qian, Yong Xie, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Key Laboratory of Digestive Diseases of Jiangxi, Nanchang 330000, Jiangxi province, China
Ying An, Ya Wang, Ying-Jun Fu, School of Pharmacy, Nanchang University, Nanchang 330000, Jiangxi province, China
Zhen Li, Medical College, Nanchang University, Nanchang 330000, Jiangxi province, China
Author contributions: Fu YJ and Xie Y designed the research; An Y, Wang Y, and Wu S performed the research; Wang YH, Qian X, and Li Z contributed to analytic tools; An Y and Wang Y analyzed data; An Y and Wang Y wrote the paper.
Supported by the Graduate Innovation Project of Nanchang University, No. CX2017213 and No. CX2017251; the National Natural Science Foundation of China, No. 81460115; and the Science and Technology Projects of Jiangxi Province, No. 2014BBG70019.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yong Xie, MD, PhD, Professor, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Key Laboratory of Digestive Diseases of Jiangxi, Nanchang 330000, Jiangxi Province, China. xieyong_tfahoncu@163.com
Telephone: +86-791-88692507
Received: April 4, 2018
Peer-review started: April 4, 2018
First decision: April 19, 2018
Revised: May 12, 2018
Accepted: June 16, 2018
Article in press: June 16, 2018
Published online: August 7, 2018
Abstract
AIM

To assess the efficacy and safety of fourth-generation quinolones for Helicobacter pylori (H. pylori) eradication, we conducted this systematic review and meta-analysis of randomized clinical trials.

METHODS

Major literature databases (PubMed, EMBASE and the Cochrane Central Register of Controlled Trials) were searched for relevant articles published prior to February 2018. We performed a meta-analysis of all randomized clinical trials that examined the efficacy of H. pylori eradication therapies and included fourth-generation quinolones in the experimental arm. Subgroup analyses by regions and different types of fourth-generation quinolones were also performed.

RESULTS

Ten studies including a total of 2198 patients were assessed. A meta-analysis of randomized controlled trials showed that the eradication rate of therapies containing non-fourth-generation quinolones was significantly lower than that of therapies containing fourth-generation quinolones by intention-to-treat (ITT) analysis [75.4% vs 81.8%; odds ratio (OR) = 0.661; 95% confidence interval (CI): 0.447-0.977; P = 0.038]. This analysis also showed that the eradication rate of the therapies containing non-fourth-generation quinolones was inferior to that of therapies containing fourth-generation quinolones by per-protocol analysis (79.1% vs 84.7%; OR = 0.663; 95%CI: 0.433-1.016; P = 0.059). Moreover, the occurrence of side effects was significantly different between the control and experimental groups by ITT analysis (30.6% vs 19.5%; OR = 1.874; 95%CI: 1.120-3.137; P = 0.017). The sub-analyses also showed significant differences in moxifloxacin therapies vs other fourth-generation quinolone therapies (84.3% vs 71.9%) and in Asian vs European groups (76.7% vs 89.1%).

CONCLUSION

Therapies containing fourth-generation quinolones achieved a poor eradication rate in the treatment of H. pylori infection. Such regimens might be useful as a rescue treatment based on antimicrobial susceptibility testing. Different antibiotics should be chosen in different regions.

Keywords: Helicobacter pylori, Fourth-generation quinolones, Eradication, Systematic review, Meta-analysis

Core tip: With the increase in the Helicobacter pylori (H. pylori) resistance rate, eradication is becoming increasingly challenging. This is the first meta-analysis comprehensively focused on fourth-generation quinolones for the treatment of H. pylori infection. Additionally, we found that fourth-generation quinolones had a higher eradication rate (81.8%) and a lower rate of incidence of side effects (19.5%). These findings will provide a specific basis for the clinical use of fourth-generation quinolones for H. pylori eradication.