ArticleClinical and experimental gastroenterology2012
Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori.
Article in Clinical and experimental gastroenterology, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers, 5 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
49 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- ACG Clinical Guideline: Treatment of Helicobacter pylori Infection.The American journal of gastroenterology · 2017Guideline
- Sequential versus standard triple first-line therapy for Helicobacter pylori eradication.The Cochrane database of systematic reviews · 2016Pooled it
- Comparative effectiveness and tolerance of treatments for Helicobacter pylori: systematic review and network meta-analysis.BMJ (Clinical research ed.) · 2015Pooled it
- Treatment of Helicobacter pylori Infection in Korea: A Systematic Review and Meta-analysis.Journal of Korean medical science · 2015Pooled it
- Global eradication rates for Helicobacter pylori infection: systematic review and meta-analysis of sequential therapy.BMJ (Clinical research ed.) · 2013Pooled it
- Oral Hygiene With Neutral Electrolyzed Water and Systemic Therapy Increases Gastric Helicobacter pylori Eradication and Reduces Recurrence.Clinical and experimental dental research · 2024Trial
- Comparison of Second-Line Quadruple Therapies with or without Bismuth for Helicobacter pylori Infection.BioMed research international · 2015Trial
- Sequential versus concomitant therapy for eradication of Helicobacter Pylori in patients with perforated duodenal ulcer: A randomized trial.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology AssociationTrial
- Article
- Current Understanding of Optimal Prevention of Helicobacter pylori-Induced Cancer.Gastroenterology clinics of North America · 2025Review
- Unravelling Peptic Ulcers: Comprehensive Insights into Etiology, Diagnosis, Screening Techniques, and Treatment.Current pharmaceutical design · 2025Review
- Sequential versus Standard Triple Therapy for First-LineAntibiotics (Basel, Switzerland) · 2024Review
- Review
- Ten-day tegoprazan-based concomitant therapy as a first-line treatment for Helicobacter pylori eradication.The Korean journal of internal medicine · 2023Article
- The Challenges of Eradicating PediatricChildren (Basel, Switzerland) · 2022Review
- Update on the first-line treatment ofTherapeutic advances in gastroenterology · 2022Review
- Revisiting Therapeutic Strategies forMolecules (Basel, Switzerland) · 2021Review
- Helicobacter pylori infection and antibiotic resistance - from biology to clinical implications.Nature reviews. Gastroenterology & hepatology · 2021Review
- Randomized Clinical Trial Comparing Concomitant and Tailored Therapy for Eradication ofJournal of personalized medicine · 2021Article
- BestAntibiotics (Basel, Switzerland) · 2020Review
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTraditional standard triple therapy for Helicobacter pylori (H. pylori) infection (proton pump inhibitor-clarithromycin-amoxicillin) can easily be converted to non-bismuth quadruple (concomitant) therapy by the addition of a nitroimidazole twice daily.
aimTo critically review evidence on the role of non-bismuth quadruple therapy (proton pump inhibitor-clarithromycin-amoxicillin-nitroimidazole) in the treatment of H. pylori infection.
methodsBibliographical searches were performed in MEDLINE and relevant congresses up to December 2011. We performed a meta-analysis of the studies evaluating the concomitant therapy, and of the randomized controlled trials comparing the concomitant and the standard triple therapy.
resultsA meta-analysis of 19 studies (2070 patients) revealed a mean H. pylori cure rate (intention-to-treat) of 88% (95% confidence interval from 85% to 91%) for non-bismuth quadruple therapy. We performed a meta-analysis of the randomized controlled studies comparing the concomitant (481 patients) and the standard triple therapy (503 patients). The former was more effective than the latter: 90% versus 78% (intention-to-treat analysis). Results were homogeneous (I(2) = 0%). The odds ratio for this comparison was 2.36 (95% confidence interval from 1.67 to 3.34). A tendency toward better results with longer treatments (7-10 days versus 3-5 days) has been observed, so it seems reasonable to recommend the length of treatment achieving the highest cure rates (10 days). Clarithromycin resistance may reduce the efficacy of non-bismuth quadruple therapy, although the decrease in eradication rates seems to be far lower than in standard triple therapy. Experience with the non-bismuth quadruple therapy in patients with metronidazole-resistant strains is still very limited.
conclusionNon-bismuth quadruple (concomitant) therapy appears to be an effective, safe, and well-tolerated alternative to triple therapy and is less complex than sequential therapy. Therefore, this regimen appears well suited for use in settings where the efficacy of triple therapy is unacceptably low.
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