China: Quadruple Therapy with Doxycycline for Helicobacter pylori Infection

A recent study has revealed that 7-day and 10-day quadruple therapy with doxycycline could be an optional first-line therapy for Helicobacter pylori infection.

The study, published in the journal Helicobacter, further found the safety of regimens containing semisynthetic tetracyclines to be relatively satisfactory. The researchers, however, did not recommend the triple regimen.

There is a great concern about the trends of increasing antibiotic resistance and decreasing Helicobacter pylori eradication rate. Considering this, there arises a need for new and effective therapies for H. pylori infection. To assess the efficacy and safety of semisynthetic tetracycline regimens in H. pylori treatment, Yong Xie, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, China, and colleagues conducted a systematic review and meta-analysis.

For this purpose, the researchers searched the online databases. The outcome indicators were the eradication rate, risk ratio (RR, i.e., the risk of the semisynthetic tetracycline regimen relative to the control). Controls were patients undergoing any other treatment without semisynthetic tetracycline.

Twenty-three studies with 5240 participants were included.

Key Findings of the Study

• The eradication rates of triple regimens with semisynthetic tetracyclines in most studies were less than 70% in both the intention-to-treat (ITT) and the per-protocol (PP) analyses.
• The pooled eradication rates of quadruple therapies with doxycycline and controls were 95% and 84% in the PP analyses, respectively.
• The pooled RR associated with efficacy in the quadruple therapy with doxycycline group compared with the control group was 1.12 in the PP analysis.
• The pooled RR of side effects in the quadruple therapy with doxycycline group compared with the control group was 1.01.

Based on the findings, the authors concluded that seven-day and ten-day quadruple therapy with doxycycline might be an optional first-line therapy.

"The safety of regimens containing semisynthetic tetracyclines was relatively satisfactory. However, the triple regimen is not recommended," they wrote.

Reference

The study titled, "Doxycycline and minocycline in Helicobacter pylori treatment: A systematic review and meta-analysis," is published in the journal Helicobacter.

DOI: https://onlinelibrary.wiley.com/doi/10.1111/hel.12839