Concomitant Versus Tailored Therapy Based on Antibiotic Resistance Profiles for
Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis
#MMPMID41384272
Khalid A
; Tabish S
; Burhan M
; Saad M
; Gul I
; Abid HMF
; Hanif MS
; Abdul Samad Z
; Rasool A
; Daniyal SM
; Hassan IN
JGH Open
2025[Dec]; 9
(12
): e70307
PMID41384272
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Rising antibiotic resistance has challenged empirical regimens for Helicobacter
pylori eradication. While concomitant therapy is widely used, its effectiveness
is reduced in resistant settings. Tailored therapy, guided by antimicrobial
susceptibility testing, may improve outcomes. We performed a meta-analysis of
randomized controlled trials (RCTs) comparing tailored versus concomitant therapy
as a first-line treatment. We searched PubMed, Google Scholar, Cochrane, and
ClinicalTrials.gov through April 2025 for RCTs enrolling treatment-naïve adults
with confirmed H. pylori infection. The primary outcome was the eradication rate
by intention-to-treat (ITT) and per-protocol (PP) analyses, with adverse events
as a secondary outcome. We included eight RCTs with 2524 patients (1332 tailored,
1192 concomitant). Tailored therapy achieved higher eradication rates than
concomitant therapy in the ITT analysis (87.4% vs. 83.2%; RR?=?1.05; 95% CI:
1.00-1.10; p?=?0.05) and the PP analysis (92.6% vs. 89.1%; RR?=?1.04; 95% CI:
1.00-1.07; p?=?0.03). Furthermore, tailored therapy was associated with a
significantly lower incidence of adverse events (35.6% vs. 45.6%; RR?=?0.71; 95%
CI: 0.58-0.86; p?=?0.0007). In conclusion, tailored therapy provides modestly
higher H. pylori eradication rates and significantly fewer adverse events
compared to empirical concomitant therapy. These findings support using tailored
therapy as the preferred first-line option, particularly in regions with high
antibiotic resistance and as access to rapid molecular testing expands.
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