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Table 4 Characteristics of systematic reviews comparing triple therapy versus bismuth-based therapy (n = 9)

From: Pharmacological regimens for eradication of Helicobacter pylori: an overview of systematic reviews and network meta-analysis

Author, Year, country Last search date Disease Countries of included RCTsf Triple therapy Bismuth-based Quadruple therapy No. of studies in MA No. of patients in MA Eradication rates by ITT Eradication rates odds ratio (95 % CI) by ITTd Quality assessmente
Gene et al. 2003 Spain [38] Aug 2002 HP infection; naïve to therapy; PUD/NUD Spain (2), US/Canada, unknown PPI (ome/panto) + clarithromycin + amoxicillin Bismuth + PPI(ome/panto) + tetracycline + metronidazole 4 981 78 % vs. 81 % 0.83 (0.61–1.14)a 0
Gisbert et al. 2005 Spain [27] Sep 2004 HP infection; NUD+/−PUD; previous treatment failures Croatia, Spain (6), Belgium, Italy (4), Greece, China PPI (ome/lanso/panto) + clarithromycin + amoxicillin/nitroimidazole RBC + clarithromycin + amoxicillin 14 2205 78 % vs. 79 % Bismuth vs. triple 1.11 (0.88–1.40) +
Croatia, Italy (6), Spain, Norway, Unknown (2), The Netherlands, China PPI (ome/lanso/panto/rabe) + clarithromycin + amoxicillin/nitroimidazole RBC + clarithromycin + nitroimidazole 13 1777 80 % vs. 87 % Bismuth vs. triple 1.65 (1.15–2.37)
Taiwan, China, UK PPI (ome) + clarithromycin + amoxicillin/nitroimidazole RBC + nitroimidazole + amoxicillin 3 451 75 % vs. 73 % Bismuth vs. triple 0.92 (0.60–1.41)
Gisbert et al. 2006 Spain [28] Jul 2005 HP infection; Previous treatment failures Italy (5), China, Spain, unknown Levofloxacin-containing: levofloxacin + PPI(panto/rabe/esome/ome) + amoxicillin/rifabutin Bismuth + PPI(panto/rabe/ome) + tetracycline + metronidazole; or RBC+ tetracycline + metronidazole 8 996 81 % vs. 70 % 1.80 (0.9–3.5) 0
Not reported Levofloxacin + amoxicillin + PPI(panto/rabe/esome/ome) Bismuth + PPI(panto/rabe/ome) + tetracycline + metronidazole; or RBC+ tetracycline + metronidazole not specified Not specified Not reported 1.7 (0.71–4.0)
Saad et al. 2006 US [29] Apr 2005 HP infection; failed prior course(s) of standard triple therapy Italy (5), China Levofloxacin-containing : levofloxacin+ +amoxicillin+ Bismuth − + metronidazole + tetracycline+ 6 854 87 % vs. 60 % 1.18 (1.08–1.29)b 0
+ same PPI (ome/esome/rabe/panto)
Li et al. 2010 China [30] 1981-Mar 2009 (Published date) HP infection; previous treatment failures Germany (2), Ireland Clarithromycin-containing: clarithromycin + amoxicillin+ Bismuth+ +metronidazole + tetracycline+ 3 411 46.5 % vs. 61.9 % 0.53 (0.35–0.80) 0
+ same PPI (ome/not specified)
Korea (2), Croatia Moxifloxacin-containing: moxifloxacin + amoxicillin/metronidazole+ Bismuth + metronidazole + tetracycline+ 3 437 Not reported 1.78 (0.98–3.22)
+PPI(esome/ome)
Taiwan, Korea, China (5), Italy (2) Levofloxacin-containing: levofloxacin + amoxicillin/rifabutin+ Bismuth + metronidazole + tetracycline+ 9 928 Not reported 1.43 (0.82–2.51)
+ same PPI(esome/panto/lanso/rabe)
Luther et al. 2010 US [50] 1990–2008 (Published date) HP infection Spain (2), Greece, Australia/New Zealand, India, US/Canada, Korea, Turkey, UK Clarithromycin-containing: clarithromycin + amoxicillin+ Bismuth + metronidazole + tetracycline + 9 1679 77.0 % vs. 78.3 % Bismuth vs. triple 1.00 (0.94–1.07b 0
+PPI (ome/panto/lanso/not specified)
Wu et al. 2011 China [31] Dec 2010 HP infection; previous treatment failures China (4), Korea (2), Croatia Moxifloxacin-containing: Moxifloxacin + + amoxicillin/metronidazole+ Bismuth + metronidazole/furazolidone + tetracycline/amoxicillin/clarithromycin+ 7 787 74.9 % vs. 61.4 % 1.89 (1.38–2.58) ++
+ PPI (esome/ome/rabe)
Di Caro et al. 2012 UK [32] Oct 2010 HP infection; previous treatment failures Italy (4), Spain (2), China (4), Korea (2), Taiwan, Unknown Levofloxacin + amoxicillin-containing: levofloxacin + amoxicillin + PPI(panto/rabe/esome/ome/lanso) Bismuth quadruple therapy (not specified) 14 1331 76.5 % vs. 67.4 % 1.59 (0.98–2.58) 0
Venerito et al. 2013 Germany [39] Nov 2011 HP infection; naïve to therapy; PUD/NUD/others Spain (2), Australia/New Zealand, Greece, US/Canada, India, Korea, Turkey (2), UK, China, multi European countries Clarithromycin-containing: clarithromycin + amoxicillin+ Bismuth + tetracycline + metronidazole+ 12 2467 68.9 % vs. 77.6 % Bismuth vs. triple 0.06 (−0.01–0.13)c +
+PPI(ome/panto/lanso/not specified)
  1. HP H.pylori, PPI proton pump inhibitor, esome esomeprazole, lanso lansoprazole, ome omeprazole, panto pantoprazole, rabe rabeprazole, PUD peptic ulcer disease, NUD non-ulcer dyspepsia, MA meta-analysis, ITT intention to treat, CI confidence interval, RCT randomized controlled trials, RBC ranitidine bismuth citrate
  2. a Peto OR is reported here
  3. b Relative risk is reported here
  4. c Risk difference is reported here
  5. d OR > 1 indicates that triple therapy is associated with greater effectiveness than bismuth-based therapy and vice versa. When “Bismuth vs. triple” is specified in the form, OR > 1 indicates bismuth-based therapy is associated with greater effectiveness than triple therapy and vice versa
  6. e Quality assessment: high quality (++): majority of criteria met, little or no risk of bias and results unlikely to be changed by further research. Acceptable (+): most criteria met, some flaws in the study with an associated risk of bias and conclusions may change in the light of further studies. Low quality (0): either most criteria not met or significant flaws relating to key aspects of study design, and conclusions likely to change in the light of further studies
  7. f Countries of included RCTs: the number in the bracket represents the number of trials from the same country if more than one trials exist