Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2015; 21(8): 2522-2533
Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2522
Meta-analysis: Is combination of tetracycline and amoxicillin suitable for Helicobacter pylori infection?
Zhi-Fa Lv, Fu-Cai Wang, Hui-Lie Zheng, Ben Wang, Yong Xie, Xiao-Jiang Zhou, Nong-Hua Lv
Zhi-Fa Lv, Fu-Cai Wang, Ben Wang, Yong Xie, Xiao-Jiang Zhou, Nong-Hua Lv, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Hui-Lie Zheng, School Public Health, Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Lv ZF and Wang FC contributed equally to this work; Lv ZF, Wang FC performed the experiments, analyzed the data, and wrote the manuscript; Zheng HL analyzed the data; Wang B performed the experiments, analyzed the data and wrote the manuscript; Xie Y and Zhou XJ conceived, designed, and performed the experiments, and edited manuscript as corresponding author; Lv NH performed the experiments.
Supported by Grants from National Science and Technology Major Projects for “Major New Drugs Innovation and Development” of China, No. 2011ZX09302-007-03.
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, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, No. 17 Yongwaizhengjie, Nanchang 330006, Jiangxi Province, China. xieyong_med@163.com
Telephone: +86-791-88692507 Fax: +86-791-88623153
Received: June 18, 2014
Peer-review started: June 19, 2014
First decision: July 9, 2014
Revised: July 20, 2014
Accepted: August 28, 2014
Article in press: August 28, 2014
Published online: February 28, 2015
Abstract

AIM: To access the efficacy of combination with amoxicillin and tetracycline for eradication of Helicobacter pylori (H. pylori), thus providing clinical practice guidelines.

METHODS: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index, China National Knowledge Infrastructure, Wanfang, and Chinese Biomedical Literature databases and abstract books of major European, American, and Asian gastroenterological meetings were searched. All clinical trials that examined the efficacy of H. pylori eradication therapies and included both tetracycline and amoxicillin in one study arm were selected for this systematic review and meta-analysis. Statistical analysis was performed with Comprehensive Meta-Analysis Software (Version 2). Subgroup, meta-regression, and sensitivity analyses were also carried out.

RESULTS: Thirty-three studies met the inclusion criteria. The pooled odds ratio (OR) was 0.90 (95%CI: 0.42-1.78) for quadruple therapy with amoxicillin and tetracycline vs other quadruple regimens, and total eradication rates were 78.1% by intention-to-treat (ITT) and 84.5% by per-protocol (PP) analyses in the experimental groups. The pooled eradication rates of 14-d quadruple regimens with a combination of amoxicillin and tetracycline were 82.3% by ITT and 89.0% by PP, and those of 10-d regimens were 84.6% by ITT and 93.7% by PP. The OR by ITT were 1.21 (95%CI: 0.64-2.28) for triple regimens with amoxicillin and tetracycline vs other regimens and 1.81 (95%CI: 1.37-2.41) for sequential treatment with amoxicillin and tetracycline vs other regimens, respectively.

CONCLUSION: The effectiveness of regimens employing amoxicillin and tetracycline for H. pylori eradication may be not inferior to other regimens, but further study should be necessary.

Keywords: Helicobacter pylori, Amoxicillin, Tetracycline, Systemic review, Meta-analysis

Core tip: The combination of amoxicillin and tetracycline is an attractive alternative because of its low cost, low resistance rate, and safety. We conducted this systematic review and meta-analysis of clinical trials to compare the efficacy of the combination of amoxicillin and tetracycline with other therapies for Helicobacter pylori (H. pylori) infection. Available data suggest that 10- or 14-d quadruple regimens with amoxicillin and tetracycline can achieve acceptable eradication rates and may be suitable for the treatment of H. pylori infection.