Modified dual therapy on par with recommended regimen in H. pylori infection

A modified dual therapy as first-line treatment for H. pylori infection demonstrates equal efficacy and compliance relative to recommended regimens, reveals a study. Moreover, a generally modified dual therapy has fewer side effects.

The investigators performed a search of PubMed, Embase, and the Cochrane Library for randomized clinical trials evaluating the efficacy and safety of modified dual therapy as the initial treatment for H. pylori eradication compared with guideline-recommended first-line therapies.

They also conducted a meta-analysis using Review Manager 5.3 and estimated dichotomous data by the risk ratio (RR) with 95 percent confidence interval (CI). Finally, a subgroup analysis was done according to control groups and studies with antibiotic susceptibility tests.

Eight studies, including a total of 1,672 patients with H. pylori infection, met the eligibility criteria. Modified dual therapy achieved similar efficacy (intention-to-treat analysis: 85.83 percent vs 86.7 percent; RR, 0.99, 95 percent CI, 0.95–1.03; per-protocol analysis: 89.53 percent vs 90.45 percent; RR, 0.99, 95 percent CI, 0.96–1.02) and compliance (95.77 percent vs 95.96 percent; RR, 1.00, 95 percent CI, 0.98–1.02) compared with recommended first-line regimens.

Moreover, no significant differences were noted when comparing the eradication rate of modified dual therapy with clarithromycin triple therapy, bismuth quadruple therapy, and concomitant therapy, respectively. In subgroup analysis based on studies with antibiotic susceptibility tests, efficacy was also similar, but the modified dual therapy had fewer adverse effects (8.70 percent vs 22.38 percent; RR, 0.39, 95 percent CI, 0.28–0.54; p<0.00001).

“In an era of antibiotic resistance, modified dual therapy has been paid much attention because of simple drug composition and low resistance of amoxicillin,” the investigators said.