Standard triple therapy for Helicobacter pylori infection in China: A meta-analysis

Table 1 Characteristics of studies included in systematic review and meta-analysis

Ref.	Age	Standard triple therapy	Control group therapy	H. pylori infection initial diagnosis ⁄ re-checking	Eradication rate by ITT (standard triple therapy/control group therapy)	Side effects	Jadad scores
Geng et al[17], 2003	Adult	P A C	O A	RUT/RUT	86.6% (71/82)/71.3% (57/80)	4 /7	1
Wu et al[18], 2004	Child	O A C	O C	H or C/UBT	93.3% (56/60)/76.0% (38/50)	-	1
Gao et al[19], 2006	Adult	R A C	R A	RUT UBT/RUT UBT	93.8% (45/48)/91.5% (43/47)	4/5	1
Huang et al[15], 2013	Child	O A C	ST-10 (O A/O C M)	H, RUT ST/ H, RUT ST	64.87% (157/242)/81.4% (96/118)	61/32	2
Yan et al[16], 2011	Adult	E A C	ST-10 (E A/E C T)	H RUT/UBT H	75.10% (220/341)/75.20% (185/281)	-	2
Liu et al[22], 2011	Child	O A C	ST-10 (O A/O C M)	UBT/UBT	60.61% (20/33)/91.18% (31/34)		3
			OAM group: O A M		69.70% (23/33)
Jia et al[41], 2012	Adult	E A C	ST-10 (E A/E C L)	RUT UBT/RUT UBT	76.0% (38/50)/94.0% (47/50)	3/4	1
Zhang et al[42], 2012	Adult	R A C	ST-9 (RA/RCOrn)	UBT RUT/UBT	80.2% (89/111)/90.2% (101/112)	10/6	2
			R A C B		91.1% (102/112)	7
Li et al[43], 2012	Child	O A C	ST-10 (O A/O C F)	UBT RUT/UBT	69.7% (23/33)/91.2% (31/34)	5/4	2
Zhou et al[44], 2011	Adult	O A C	ST-10 (O A/O C L )	RUT H/RUT H	79.60% (35/44)/88.9% (40/45)	-	2
Wu et al[45], 2011	Adult	E A C	ST-10 (E A/E C T)	UBT H RUT/UBT H RUT	90.20% (46/51)/90.40% (47/52)	18/12	2
Zhu et al[46], 2010	Child	O A C	ST-10 (R A/R C T)	UBT S/UBT S	70.73% (29/41)/92.68% (76/82)	7/5	1
Zhang et al[47], 2010	Adult	P A C	ST-10 (P A/P C T)	UBT/UBT	73.0% (61/74)/92.3% (36/39)	12/6	3
Lu et al[48], 2010	Child	O A C	ST-10 (O A/O C T)	S UBT RUT/UBT	82.43% (26/36)/90% (36/40)	6/7	2
Hu et al[49], 2009	Adult	E A C	ST-10 (E A/E C T)	RUT H/UBT	77.50% (31/40)/94.87% (37/39)	8/7	2
Pang et al[50], 2009	Adult	O A C	ST-10 (O A/O C T)	RUT H UBT/RUT UBT	89.60% (60/67)/91.90% (63/69)	19/10	2
Wang et al[51], 2009	Adult	E A C	ST-10 (E A/E C T)	RUT H/UBT	76.92% (40/52)/92.00% (46/50)	12/10	1
Zhao et al[52], 2009	Adult	P A C	ST-10 (P A/P C )	H/UBT	67.24% (39/58)/83.87% (52/62)	6/5	2
Huang et al[53], 2009	Adult	O A C	ST-10 (O A/O C T)	UBT/UBT	69.2% (36/52)/92.5% (49/53)	-	1
Ma et al[54], 2008	Adult	O A C	ST-10 (O A/O C T)	RUT UBT/RUT UBT	65.1% (41/63)/83.6% (56/67)	12/11	3
Huang et al[55], 2012	Adult	E A C	ST-10 (E A/E C M)	RUT H/RUT H	78.4% (40/51)/80.0% (40/50)	9/10	3
Gao et al[56], 2010	Adult	O A C	RAB L;	RUT H/UBT	80.56% (58/71)/83.33% (60/72)	11/6	2
			ST-10 (O A/O C T)		88.89% (64/72)	14
Huang et al[61], 2012	Child	O A C	ST-10 (O A/O C M)	B C/UBT	78.8% (109/160)/85.2% (46/54)	26/6	2
Zheng et al[60], 2005	Adult	E A C	1d-E A M B	RUT H/UBT	80.50% (33/41)/38.50% (15/39)	2/1	2
Dai et al[37], 2012	Adult	E A C	E A F B	UBT/UBT	78.12% (25/35)/88.57% (31/35)	4/8	2
Xu et al[38], 2011	Adult	E A C	E A C B	UBT/UBT	73.02% (46/69)/88.71% (55/67)	7/8	3
Liu et al[39], 2010	Adult	R A C	R A C B	UBT/UBT	62.90% (39/62)/88.70% (55/62)	4/5	1
Hu et al[13], 2012	Adult	Lan A C	Lan A C B	RUT H UBT/UBT	70.00% (70/100)/88.10% (89/101)	1/2	3
Jing et al[40], 2004	Adult	O/R A C	O/R A C F	UBT/UBT	85.83% (103/120)/86.7% (40/60)	4/5	2
Zhang et al[62], 2006	Adult	Lan A C	Lan A C M	UBT/UBT	69.59% (103/157)/26.78% (64/239)	148/229	2
Luo et al[20], 2012	Adult	E A C	E A L	UBT RUT/UBT	75.8% (91/120)/80.0% (96/120)	21/19	2
Chen et al[21], 2011	Adult	R A C	R A D	UBT/UBT	61.25% (49/80)/88.75% (71/80)	-	1
Xu et al[23], 2010	Adult	E A C	E L F	H UBT RUT/UBT RUT	75.51% (37/49)/93.87% (46/49)	6/5	1
Dai et al[24], 2010	Adult	E A C	E A L	UBT RUT/UBT	82.10% (23/28)/88.90% (26/30)	2/2	2
Xu et al[25], 2009	Adult	Lan A C	Lan C M	RUT UBT H/UBT	83.87% (26/31)/60.00% (21/35)	4/5	1
Wang et al[26], 2008	Adult	E A C	A C B	RUT H/UBT	80.0% (16/20)/85.00% (17/20)	10/10	2
Hu et al[27], 2008	Adult	O A C	O A L	RUT UBT/UBT	85.70% (36/45)/90.20% (37/45)	2/2	2
Su et al[28], 2005	Child	O A C	A M B	RUT H UBT/UBT	92.5% (74/80)/74.19% (92/124)	16/24	2
Mou et al[29], 2004	Adult	O A C	O C Gm	C H RUT/RUT H UBT	84.20% (16/19)/80.00% (20/25)	9/12	1
Chen et al[30], 2002	Adult	O A C	L B F	RUT H/RUT H	88.20% (97/110)/86.70% (92/106)	4/0	1
Chen et al[31], 1996	Adult	O A C	A M B	RUT H/RUT H	89.6% (43/48)/83.87% (78/93)	50/59	2
Cheng et al[32], 2010	Adult	Lan A C	Lan A L	UBT RUT/UBT	74.50% (111/149)/82.99% (122/148)	5/9	3
Zeng et al[33], 2007	Adult	O A C	O A L	UBT/UBT	68.30% (28/41)/86.50% (32/37)	6/5	1
Gao et al[34], 2005	Adult	O A C	A C B	H/H	83.33% (25/30)/86.67% (26/30)	0/2	2
Chen et al[35], 2004	Adult	O A C	O A Am	UBT/H	93.33% (42/45)/92.72% (51/55)	8/3	2
Chen et al[36], 2005	Adult	O A C	O A Am	UBT H/UBT H	88.50% (23/26)/86.70% (26/30)	2/2	1
He et al[58], 2004	Adult	R A C	R C M	C/UBT	85.90% (55/64)/54.70% (35/64)	-	2
Guo et al[58], 2004	Adult	O A C	O F C/O M C /O F A	RUT S H/UBT	84.90% (28/33)/73.74% (73/99)	9/19	2
Sun et al[59], 2005	Adult	O A C	O A M	B /RUT H	86.20% (50/58)/82.20% (37/45)	6/5	2

O: Omeprazole, A: Amoxicillin; B: Bismuth; C: Clarithromycin; M: Metrodinazole, P: Pantoprazole; E: Esomeprazole; Lan: Lansoprazole; D: Doxycycline; F: Furazolidone, L: Levofloxacin; R: Rabeprazole, T: Tinidazole; Orn: Ornidazole; Am: Azithromycin; Gm: Gentamycin; B: Biopsy based test; C: Culture; UBT: Urea breath test; H: Histology, PCR: Polymerase chain reaction; RUT: Rapid urease test; S: Serology; ST: Stool test; ITT: Intention to treat; -: Not reported; H. pylori: Helicobacter pylori. ST-10 (O A/O C T): Sequential therapy lasting 10 d (O A for the first 5 d, O C T for the remaining 5 d); ST-10 (P A/P C): Sequential therapy lasting 10 d (P A for the first 5 d, P C for the remaining 5 d); ST-10 (E A/E C T): Sequential therapy lasting 10 d (E A for the first 5 d, E C T for the remaining 5 d); ST-10 (P A/P C T): Sequential therapy lasting 10 d (P A for the first 5 d, P C T for the remaining 5 d); ST-10 (R A/R C T): Sequential therapy lasting 10 d (R A for the first 5 d, R C T for the remaining 5 d); ST-10 (O A/O C L): Sequential therapy lasting 10 d (O A for the first 5 d, O C L for the remaining 5 d); ST-10 (O A/O C M): Sequential therapy lasting 10 d (O A for the first 5 d, O C M for the remaining 5 d); ST-10 (E A/E C L): Sequential therapy lasting 10 d (E A for the first 5 d, E C L for the remaining 5 d); ST-10 (E A/E C M): Sequential therapy lasting 10 d (E A for the first 5 d, E C M for the remaining 5 d); ST-10 (O A/O C F): Sequential therapy lasting 10 d (O A for the first 5 d, O C F for the remaining 5 d); ST-9 (RA/RCOrn): Sequential therapy lasting 9 d (R A for the first 4 d, R C Orn for the remaining 5 d).

Table 2 Results of meta-analysis

Meta-analyses/subgroup analyses	Eradication rate with control group	RR (95%CI)	I2
Standard triple therapy vs dual therapy	78.00%	1.140 (0.992–1.310)	62.596%
7-d subgroup	73.08%	1.221 (1.084 –1.374)	0.000%
Adverse events		0.651 (0.276–1.539)	0.000%
Standard triple therapy vs sequential therapy	84.00%	0.863 (0.824–0.904)	37.400%
Adult subgroup	82.90%	0.899 (0.861–0.939)	25.942%
Child subgroup	87.29%	0.779 (0.722–0.840)	0.000%
7-d subgroup	87.52%	0.800 (0.752–0.851)	0.000%
10-d subgroup	80.17%	0.849 (0.789–0.913)	42.355%
14-d subgroup	89.72%	0.980 (0.916–1.048)	0.000%
Omeprazole subgroup	87.37%	0.832 (0.772–0.898)	47.049%
Esomeprazole subgroup	77.01%	0.932 (0.871–0.998)	40.061%
Pantoprazole subgroup	87.13%	0.846 (0.746–0.960)	0.000%
Rabeprazole subgroup	91.24%	0.847 (0.766–0.936)	41.871%
Tinidazole subgroup	81.43%	0.889 (0.837–0.944)	38.688%
Metronidazole subgroup	83.20%	0.810 (0.745–0.882)	43.630%
Adverse events		1.176 (0.975–1.419)	0.000%
Standard triple therapy vs quadruple therapy	64.90%	1.073 (0.849–1.357)	93.204%
1-d subgroup	28.42%	2.367 (1.923–2.914)	0.000%
3-d subgroup	66.67%	1.288 (1.061–1.562)	100.000%
7-d subgroup	86.79%	0.790 (0.718–0.868)	0.000%
10-d subgroup	88.04%	0.917 (0.839–1.002)	22.259%
Omeprazole subgroup	66.67%	1.250 (1.012–1.545)	100.000%
Esomeprazole subgroup	73.76%	1.098 (0.699–1.725)	88.852%
Lansoprazole subgroup	45.00%	1.391 (0.404–4.790)	98.719%
Rabeprazole subgroup	83.99%	0.948 (0.771–1.166)	84.733%
Adverse events		0.940 (0.825–1.072)	0.000%
Standard triple therapy with other triple therapies	79.90%	1.010 (0.936–1.089)	72.233%
Adult subgroup	80.92%	0.999 (0.925–1.078)	69.085%
Child subgroup	73.25%	1.079 (0.748–1.557)	74.810%
7-d subgroup	80.32%	1.022 (0.949–1.100)	60.674%
10-d subgroup	77.78%	0.933 (0.821–1.060)	0.000%
14-d subgroup	78.40%	1.050 (0.712–1.549)	93.921%
Omeprazole subgroup	80.30%	1.048 (0.976–1.125)	49.506%
Esomeprazole subgroup	84.47%	0.911 (0.831–0.999)	0.000%
Levofloxacin subgroup	82.37%	0.917 (0.852–0.987)	0.000%
Furazolidone subgroup	85.22%	0.963 (0.762–1.216)	73.898%
Metronidazole subgroup	68.84%	1.119 (0.882–1.420)	80.863%
Adverse events		1.081 (0.848–1.378)	0.000%
Eradication rate with standard triple therapy		74.5%