Iqbal Umair, Khara Harshit S, Akhtar Daud, Hu Yirui, Anwar Hafsa, Haq Khwaja F, Siddiqui Hafiz U, Bergenstock Marika K, Shellenberger Matthew J
Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA 17822, USA.
Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
Gastroenterology Res. 2020 Dec;13(6):260-268. doi: 10.14740/gr1342. Epub 2020 Dec 23.
(HP) is the most common cause of gastritis worldwide. Clarithromycin-based triple therapy or bismuth-based quadruple therapy is usually considered the first-line treatment, however with around 30% failure rate for both regimens. Drug resistance of clarithromycin and metronidazole is a growing concern in some parts of the world. Therefore, there is a need for effective eradication regimen for HP. Nitazoxanide, a bactericidal thiazolide antibiotic, has been shown to be effective in HP infection. We conducted a systematic review and meta-analysis to evaluate the efficacy of nitazoxanide-based regimen for the eradication of HP.
We have searched PubMed, Embase, Ovid Medline and Cochrane library database from inception to December 9, 2020 to identify studies that utilized nitazoxanide in the treatment regimen for HP eradication. Our primary outcome was pooled eradication rate of HP.
Thirteen studies including 1,028 patients met our inclusion criteria and were analyzed in a meta-analysis. HP eradication was successful in 867 patients with a pooled eradication rate of 86% (95% confidence interval (CI): 79-90%) with 84% heterogeneity. A subgroup analysis that included 230 patients who failed other prior eradication regimens revealed a pooled eradication rate of 85% (95% CI: 69-94%) without heterogeneity. In a subgroup analysis, highest eradication rates were achieved with levofloxacin, doxycycline, nitazoxanide and proton pump inhibitor with a pooled eradication rate of 92% (88-95%).
Nitazoxanide-based regimen is safe and effective in the eradication of HP infection. It is also successful as a salvage therapy in patients who have failed prior treatments.
幽门螺杆菌（HP）是全球胃炎最常见的病因。基于克拉霉素的三联疗法或基于铋剂的四联疗法通常被视为一线治疗方法，然而这两种方案的失败率均约为30%。在世界某些地区，克拉霉素和甲硝唑的耐药性问题日益受到关注。因此，需要一种有效的根除幽门螺杆菌方案。硝唑尼特是一种具有杀菌作用的噻唑类抗生素，已被证明对幽门螺杆菌感染有效。我们进行了一项系统评价和荟萃分析，以评估基于硝唑尼特的方案根除幽门螺杆菌的疗效。
我们检索了从数据库建立至2020年12月9日的PubMed、Embase、Ovid Medline和Cochrane图书馆数据库，以确定在根除幽门螺杆菌治疗方案中使用硝唑尼特的研究。我们的主要结局是幽门螺杆菌的综合根除率。
13项研究（包括1028例患者）符合我们的纳入标准，并进行了荟萃分析。867例患者幽门螺杆菌根除成功，综合根除率为86%（95%置信区间（CI）：79 - 90%），异质性为84%。一项亚组分析纳入了230例先前其他根除方案失败的患者，其综合根除率为85%（95%CI：69 - 94%），无异质性。在一项亚组分析中，左氧氟沙星、多西环素、硝唑尼特和质子泵抑制剂联合使用时根除率最高，综合根除率为92%（88 - 95%）。
基于硝唑尼特的方案在根除幽门螺杆菌感染方面安全有效。作为挽救疗法，它对先前治疗失败的患者也很成功。
