Meta-analysis: sequential therapy for Helicobacter pylori eradication in children

Summary Background Problems with the standard triple treatment recommended for Helicobacter pylori eradication therapy include unsatisfactory (less than 80%) eradication rates among children. Aim To assess the evidence for sequential therapy compared with triple therapy on H. pylori eradication rates in children. Methods The Cochrane Library, MEDLINE and EMBASE databases were searched in May 2012, with no language restrictions, as were abstracts from major gastroenterology conferences, for randomised controlled trials (RCTs) comparing sequential therapy with standard triple therapy for H. pylori eradication. Additional references were obtained from reviewed articles. Authors were contacted for extra information. Dichotomous data were pooled to obtain the relative risk (RR) of the eradication rate, with a 95% CI. Results Ten RCTs involving a total of 857 children aged 3–18 years met the inclusion criteria. Of the 409 patients in the sequential therapy group, 318 (78%, 95% CI 73–82) experienced eradication compared with 314 of the 444 patients (71%, 95% CI 66–75) in the standard triple therapy group (RR 1.14, 95% CI 1.06–1.23, number needed to treat 15; fixed-effects model). Sequential therapy was superior to 7-day standard triple therapy, but was not significantly better than 10-day or 14-day triple therapy. There were no significant differences between groups in the risk of adverse effects. Conclusions The pooled evidence suggests that 10-day sequential therapy compared with standard triple therapy may be considered as an option for increasing the eradication rates in children; however, it is still less than desired.