Korean J Helicobacter Up Gastrointest Res.  2021 Mar;21(1):35-47. 10.7704/kjhugr.2020.0056.

Eradication Rates of Clarithromycin Triple Therapy in Korea: A Systematic Review and Meta-analysis

Affiliations
  • 1Department of Internal Medicine, Seoul National University Hospital Gangnam Center, Seoul, Korea
  • 2Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
  • 3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 4Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 5Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
  • 6Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
  • 7Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
  • 8Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
  • 9Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
  • 10Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
  • 11Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University Hospital Chilgok Hospital, Daegu, Korea
  • 12Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
  • 13Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
  • 14Center for Gastric Cancer, National Cancer Center, Goyang, Korea
  • 15Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
  • 16Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea

Abstract

Background/Aims
Standard triple therapy, including a proton pump inhibitor, clarithromycin, and amoxicillin, has been recommended as the first-line for Helicobacter pylori infection. However, the eradication rate of standard triple therapy has declined over the past years because of the increasing resistance to clarithromycin in Korea. We analyzed the eradication rates and the 10-year change in the eradication rates in Korea.
Methods
PubMed, EMBASE, the Cochrane Library, and KoreaMed were searched for studies published between January 2007 and June 2018. The pooled eradication rates and their 95% CIs were estimated using a random-effect logistic regression model.
Results
Twenty-six randomized controlled studies on standard triple therapy conducted in Korea were selected. The intention-to-treat (ITT) and per protocol analyses showed pooled eradication rates of standard triple therapy of 71.6% (95% CI, 69.9~73.3%) and 79.6% (95% CI, 76.6~82.2%), respectively. The eradication rate decreased with time. The ITT analysis showed that the 14-day therapy (78.1% [95% CI, 75.2~80.7%]) had significantly higher eradication rates than the 7-day therapy (70.0% [95% CI, 68.5~71.4%]) (P<0.01).
Conclusions
These results suggest that the eradication rate of standard triple therapy, as the first-line therapy, has shown an unacceptable decrease. The eradication rate increased when the duration of therapy was increased to 14 days, but it was not satisfactory. Therefore, other treatment regimens or therapies based on susceptibility tests should be considered for the first-line therapy.

Keyword

Clarithromycin; Disease eradication; Meta-analysis
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