Eradication of Helicobacter pylori infection: Which regimen first?

Table 1 Recommended first-line therapies for Helicobacter pylori infections

	Treatment	Days	No. of patients	Methods of evaluating eradication	Eradication rate % (ITT)	Eradication rate % (PP)	Adverse effects %	Ref.	Type of study
Low clarithromycin resistance area (< 20%)	PPI (standard dose, bid) + amoxicillin (1 g, bid) + clarithromycin (500 mg, bid)	7-10	1975	UBT or H or R	Overall77.3-100		0-33	Mégraud et al[26]	Meta-analysis
	PPI (standard dose, bid) + amoxicillin (1 g, bid) followed by a triple therapy with a PPI (standard dose, bid) + clarithromycin (500 mg, bid) + metronidazole/tinidazole (500 mg, bid)	5 + 5	5666	UBT or H or R	Overall 84.3		0-44	Gatta et al[35]	Meta-analysis
High clarithromycin resistance area (≥ 20%)	PPI (standard dose, bid) + amoxicillin (1 g, bid) + levofloxacin (250 mg, bid)	7-10	900	UBT or H or R	Overall72-96		0-52	Berning et al[32]	Meta-analysis
	PPI (standard dose, bid) + amoxicillin (1 g, bid) followed by a triple therapy with a PPI (standard dose, bid) + levofloxacin (250/500 mg, bid) + tinidazole (500 mg, bid).	5 + 5	250	UBT	96/96.8	98.3/98.4	22.1-23.5	Romano et al[46]	RCT
	PPI (standard dose, bid) + amoxicillin (1 g, bid) + clarithromycin (500 mg, bid) + metronidazole (500 mg, bid)	5	135	UBT	91.4	91.4	35.6	Kim et al[54]	RCT
	PPI (high dose, bid) + amoxicillin (1 g, bid) + levofloxacin (500 mg, bid) + tinidazole (500 mg, bid)	5	90	UBT	92.2	96.5	27.8	Federico et al[47]	RCT
	PPI (standard dose, bid) + metronidazole (500 mg, bid) + bismuth (120 mg, q.i.d.) + tetracycline (500 mg, q.i.d.)	10	218	UBT	92	94	47	Malfertheiner et al[18]	RCT
	PPI (high dose, bid) + amoxicillin (1 g, bid) followed by a quadruple therapy with a PPI (high dose, bid) + amoxicillin (1 g, bid) + clarithromycin (500 mg, bid) + metronidazole (500 mg, bid)	7 + 7	171	UBT	90	92	47	Molina-Infante et al[66]	RCT

PPI: Proton pump inhibitor; UBT: Urea breath test; H: Histology; R: Rapid urease test; RCT: Randomized controlled trial; PP: Per-protocol; ITT: Intention-to-treat.