Optimizing clarithromycin-containing therapy for Helicobacter pylori in the era of antibiotic resistance

Table 1 Impact of adding probiotics to eradication therapy (mostly standard triple therapy) on eradication rates and side effects, evaluated in seven recent meta-analyses

Ref.	Probiotic strains	Eradication rates	Side effects
Tong et al[24], 2007	Lactobacillus and bifidobacterium	Significant	Significant
Wang et al[25], 2013		increase	Reduction
Sachdeva et al[26], 2009	Lactoferrin	Significant	Significant
Zou et al[27], 2009		Increase	Reduction/No impact
Sachdeva et al[28], 2009	Fermented milk	Significant Increase	No impact
Zou et al[29], 2009	Lactobacillus	Significant	Significant
		Increase	reduction
Szajewska et al[30], 2010	Saccharomyces boulardii	Significant increase	Significant reduction

Table 2 Updated systematic reviews and meta-analyses (2008-2012) in children and adults comparing triple and sequential therapy for Helicobacter pylori infection

Ref.	Population and timeframe	n	Triple therapy (95%CI)	Sequential therapy (95%CI)	P value
Horvath et al[49], 2012	Children 2005-2012	857	71% (66-75)	78% (73-82)
Zullo et al[50], 2013	Adults and children 2008-2012	2921	75.8% (73.5–78.1)	80.6% (78.5–82.7)	0.003
Kate et al[51], 2013	Adults and children 2008-2012	3247	71.4% (64-78)	81.7% (78-85)	0.02

Table 3 Efficacy of sequential and concomitant therapy, with a duration of 10 to 14 d, on dual clarithromycin-metronidazole resistant Helicobacter pylori strains n (%)

Ref.	Treatment duration (d)	Patients	Eradication rates
Concomitant therapy
Wu et al[61], Thailand, 2010	10	4	3 (75)
Huang et al[62], China, 2012	10	2	2 (100)
Molina-Infante et al[63], Spain, 2012	10	4	3 (75)
Molina-Infante et al[65], Spain-Italy, 2013	14	3	3 (100)
Georgopoulos et al[66], Greece, 2013	10	10	7 (70)
Total		23	18 (78)
Sequential therapy
Vaira et al[39], Italy, 2007	10	4	0 (0)
Liou et al[52], Taiwan, 2013	14	8	3 (37)
Wu et al[61], Thailand, 2010	10	3	1 (33)
Huang et al[62], China, 2012	10	4	2 (50)
Molina-Infante et al[63], Spain, 2012	10	5	3 (60)
Romano et al[70], Italy, 2010	10	3	0 (0)
Total		27	9 (33)

Adapted from Georgopoulos et al[71], with permission.