A meta-analysis of triple vs. quadruple therapy for Helicobacter pylori infection.

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By nclexnursing

The first-line treatment for Helicobacter pylori infection is triple therapy (proton pump inhibitor, clarithromycin, and amoxicillin or an imidazole). However, due to the rise of antibiotic resistance, triple therapy’s effectiveness is dwindling. Even in places with a high frequency of antibiotic resistance, quadruple therapy (proton pump inhibitor, tetracycline, metronidazole, and a bismuth salt) is a very successful regimen and may be an alternative first-line treatment.


The goal of this study was to see how triple vs. quadruple therapy was performed in the first-line treatment of H. pylori infection.


A thorough search of the literature was conducted to find randomized trials comparing triple vs. quadruple therapy. Review Manager 4.1 was used to conduct a meta-analysis of selected trials.


The criteria for inclusion were met by four studies. In both the intention-to-treat (81 percent vs. 78 percent; odds ratio, 0.83; 95 percent confidence interval, 0.61-1.14) and per-protocol (88 percent vs. 85 percent; odds ratio, 0.81; 95 percent confidence interval, 0.55-1.20) analyses, quadruple therapy had slightly higher eradication rates, though the differences were not statistically significant. There were no notable variations in compliance or side effects amongst the treatments.


When used as first-line treatment for H. pylori infection, triple and quadruple regimens appear to be fairly equal in terms of effectiveness, compliance, and side-effect profile.

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