Objective: To perform a systematic review of the world literature to determine current success rates of Helicobacter pylori eradication treatment.
Methods: Computer searches were performed to identify systematic reviews or meta-analyses of treatment studies of H pylori infection. The searches included specifications for Asia, Africa, North America, South America and Europe.
Results: The data supported the current worldwide recommendation to use proton pump inhibitor (PPI)-based triple therapy with clarithromycin and either metronidazole or amoxycillin. There are, however, regional differences in success rates that are not completely explained by resistance to either metronidazole or amoxycillin. For second-line therapy, quadruple therapy using a PPI with bismuth, metronidazole and tetracycline (PPI-BMT) is superior to an alternative PPI-based triple therapy.
Conclusion: There is worldwide consensus that PPI-based triple therapy, preferably with clarithromycin and amoxycillin or clarithromycin and metronidazole, is used as first-line therapy. Quadruple therapy of PPI-BMT is the preferred rescue medication after initial failure of therapy.