Rokkas Theodore, Ekmektzoglou Konstantine, Graham David Y
Gastroenterology Clinic, Henry Dunant Hospital, Athens, Greece.
Medical School, European University of Cyprus, Nicosia, Cyprus.
Helicobacter. 2023 Feb;28(1):e12936. doi: 10.1111/hel.12936. Epub 2022 Dec 1.
Recent guidelines dictate that all Helicobacter pylori (H. pylori) infected subjects should receive curative therapy. The efficacy of empirical regimens for H. pylori eradication might decline with bacterial, drug, and host factors. The necessity of a tailored therapy still remains controversial. Here we provide a meta-analysis of the current status of susceptibility-based (tailored) therapy in which susceptibility-based therapies were compared to the currently accepted choice of empiric therapy. In this rapidly closing era, neither the susceptibility nor empiric therapies were routinely optimized, such that we report the outcome of comparisons on the efficacy of unoptimized tailored vs. locally preferred empiric treatments.
PubMed, Medline, and Embase databases were searched using suitable keywords. Individual and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the fixed- or random-effects model as appropriate. Heterogeneity was calculated employing the Cochrane Q test and I values, whereas the possibility of publication bias was examined by constructing funnel plots. Additionally, subgroup and sensitivity analyses were performed.
Thirty-four studies were included with a total of 9613 patients. Tailored therapy proved superior to empiric treatment [OR 2.07 (95% CI 1.53-2.79)]. However, tailored therapy achieved eradication rates >90% in only 15 (44%) studies and >95% in only 6 (17.6%).
Although tailored therapy performed better than empiric treatment, the lack of optimization of therapies failed to reliably achieve high cure rates (>90%). These results emphasize that H. pylori infection, like other infectious diseases, should utilize the principles of antimicrobial stewardship in relation to treatment guidance.
近期指南规定，所有幽门螺杆菌（H. pylori）感染患者均应接受根治性治疗。幽门螺杆菌根除经验性治疗方案的疗效可能会因细菌、药物和宿主因素而下降。个体化治疗的必要性仍存在争议。在此，我们对基于药敏的（个体化）治疗现状进行了荟萃分析，将基于药敏的治疗与目前公认的经验性治疗选择进行了比较。在这个迅速结束的时代，药敏治疗和经验性治疗均未常规优化，因此我们报告了未优化的个体化治疗与当地首选经验性治疗疗效比较的结果。
使用合适的关键词检索PubMed、Medline和Embase数据库。根据情况使用固定效应模型或随机效应模型计算个体和合并比值比（OR）及95%置信区间（CI）。采用Cochrane Q检验和I值计算异质性，通过构建漏斗图检验发表偏倚的可能性。此外，还进行了亚组分析和敏感性分析。
纳入34项研究，共9613例患者。个体化治疗被证明优于经验性治疗[OR 2.07（95%CI 1.53 - 2.79）]。然而，个体化治疗仅在15项（44%）研究中根除率>90%，仅在6项（17.6%）研究中根除率>95%。
尽管个体化治疗比经验性治疗效果更好，但治疗缺乏优化未能可靠地实现高治愈率（>90%）。这些结果强调，幽门螺杆菌感染与其他传染病一样，在治疗指导方面应遵循抗菌药物管理原则。
