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lüll Triple vs quadruple therapy for treating Helicobacter pylori infection: a meta-analysis Gene E; Calvet X; Azagra R; Gisbert JPAliment Pharmacol Ther 2003[May]; 17 (9): 1137-43BACKGROUND: Triple therapy (proton pump inhibitor, clarithromycin and amoxicillin or an imidazole) is the first-line treatment for Helicobacter pylori infection. However, the effectiveness of triple therapy is decreasing due to the increase in antibiotic resistance. Quadruple therapy (proton pump inhibitor, tetracycline, metronidazole and a bismuth salt) is a very effective regimen even in areas of high prevalence of antibiotic resistance, and may be an alternative first-line treatment. AIM: To compare triple vs. quadruple therapy for the first-line treatment of H. pylori infection. METHODS: An extensive literature search was performed to identify randomized trials comparing triple vs. quadruple therapy. Selected trials were included in a meta-analysis using Review Manager 4.1. RESULTS: Four studies met the inclusion criteria. Eradication rates with quadruple therapy were slightly higher in both the intention-to-treat (81% vs. 78%; odds ratio, 0.83; 95% confidence interval, 0.61-1.14) and per protocol (88% vs. 85%; odds ratio, 0.81; 95% confidence interval, 0.55-1.20) analysis, although the differences were not statistically significant. Nor were there significant differences in compliance or adverse effects between the therapies. CONCLUSION: Triple and quadruple therapies seem to be roughly equivalent in terms of effectiveness, compliance and side-effects profile when administered as first-line treatment for H. pylori infection.|*Helicobacter pylori[MESH]|Amoxicillin/administration & dosage[MESH]|Antacids/administration & dosage[MESH]|Anti-Bacterial Agents/*administration & dosage[MESH]|Bismuth/administration & dosage[MESH]|Clarithromycin/administration & dosage[MESH]|Ditiocarb/administration & dosage[MESH]|Drug Resistance, Bacterial[MESH]|Drug Therapy, Combination/administration & dosage[MESH]|Helicobacter Infections/*drug therapy[MESH]|Humans[MESH]|Metronidazole/administration & dosage[MESH]|Proton Pump Inhibitors[MESH]|Randomized Controlled Trials as Topic[MESH]|Tetracycline/administration & dosage[MESH] |