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lüll First-line eradication of Helicobacter pylori: are the standard triple therapies obsolete? A different perspective Buzas GMWorld J Gastroenterol 2010[Aug]; 16 (31): 3865-70Studies concerning the eradication of Helicobacter pylori have resulted in a proliferation of meta-analyses. To date, there are 303 meta-analyses cited in PubMed, 113 dealing with the therapy of the infection. A chronological analysis of the results of meta-analyses performed between 1998 and 2010 shows that first-line standard triple therapies achieved eradication rates on an intention-to-treat basis of around 80%; prolonging treatment to 14, but not 10 d should improve the results. The proton pump inhibitors have a similar efficiency, and giving a double dose is more efficient than the standard doses of these drugs. Triple and quadruple therapies proved to be equivalent. Based on meta-analytical data, the decrease in efficiency over time cannot be substantiated: eradication rates < 80% followed from the introduction of triple therapies. As alternatives, ranitidine bismuth citrate-, levofloxacin- or furazolidone-based therapies were shown to obtain the same eradication rates as standard triple regimens. Sequential therapies and quadruple non-bismuth-based therapies were superior to standard triple therapies but their use is limited to certain countries. In the author's opinion, and from a meta-analytical viewpoint, standard triple therapies cannot yet be considered obsolete. Furthermore, non-inferiority trials are proposed for the future, including assessment of local contemporary antimicrobial resistance profiles and the CagA and CYP2C19 status of the enrolled patients.|Anti-Bacterial Agents/*therapeutic use[MESH]|Drug Therapy, Combination[MESH]|Evidence-Based Medicine[MESH]|Helicobacter Infections/*drug therapy/microbiology[MESH]|Helicobacter pylori/*pathogenicity[MESH]|Humans[MESH]|Meta-Analysis as Topic[MESH]|Patient Selection[MESH]|Proton Pump Inhibitors/*therapeutic use[MESH]|Treatment Failure[MESH] |