Azithromycin-containing versus standard triple therapy for Helicobacter pylori eradication: A meta-analysis

AIM: To evaluate whether adding azithromycin to first-line Helicobacter pylori (H pylori) eradication improved eradication and reduced side effects.

METHODS: Eligible articles were identified by searches of electronic databases. We included all randomized trials that compared azithromycin-containing with standard triple-therapy regimens for first-line treatment of H pylori infection. Statistical analysis was performed with Review Manager 5.0.10. Sub-analyses were also performed.

RESULTS: We identified 14 randomized trials (1431 patients). Pooled H pylori eradication rates were 72.01% (95% CI: 58.09%-85.93%) and 69.78% (95% CI: 66.47%-73.09%) for patients with or without azithromycin by intention-to-treat analysis, and the odds ratio (OR) was 1.17 (95% CI: 0.64-2.14). The occurrence of side effects differed significantly and was 15.81% (95% CI: 12.50%-19.12%) and 25.20% (95% CI: 21.44%-28.96%) for treatment with or without azithromycin, respectively, and the summary OR was 0.58 (95% CI: 0.41-0.82). Furthermore, the azithromycin-containing group had a lower occurrence of diarrhea, nausea and taste disturbance.

CONCLUSION: Our review suggests that azithromycin-containing triple-therapy regimens could be equally effective in eradication of H pylori compared with standard first-line triple-therapy regimens.