Work

Efficacy and safety of antibiotic regimens for Helicobacter pylori eradication: a systematic review and meta-analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background Helicobacter pylori infection, a global health concern, is treated with various antibiotic regimens, but rising resistance causes variable outcomes. This meta-analysis evaluated the efficacy and safety of different eradication regimens. Methods PubMed, Embase, and Web of Science were searched from inception to October 2025. Randomized and observational studies reporting eradication rates or adverse events were included. Pooled estimates were calculated using random-effects models with subgroup analyses and meta-regression. Results Fifty-seven studies (19,941 participants, 127 arms) were included. The pooled eradication rate was 83.0% (95% CI: 81.4%–84.5%; I²=87.3%). Egger's and Begg's tests indicated publication bias (both P <0.001); trim-and-fill adjusted rate was 78.1%. Subgroup analyses showed sequential (84.3%), quadruple (83.3%), and dual therapy (83.8%) achieved slightly higher rates than triple therapy (79.2%). PCAB-based regimens outperformed PPI-based (85.3% vs. 81.6%). Ten-day regimens yielded higher rates (85.9%) than 7-day (79.8%) or 14-day (82.7%). Regimens with three antibiotics (86.9%) or nitroimidazoles (84.8%) showed improved efficacy. Meta-regression identified publication year, continent, study design, and acid suppressant as heterogeneity sources (all P <0.01). For safety (54 studies, 119 arms, 5,202 events), pooled adverse event incidence was 26.1% (95% CI: 21.0%–31.9%; I²=95.3%). Sequential therapy had the highest incidence (54.1%), dual therapy the lowest (15.8%). Regimens with three antibiotics (52.6%), macrolides (29.0%), or nitroimidazoles (37.1%) were associated with more adverse events. Conclusions Eradication regimens vary in efficacy and safety; treatment selection should balance these factors. Findings require confirmation due to high heterogeneity and between-study comparisons. Systematic review registration CRD420251207695, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251207695 .

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1780052

Authors: Yinhua Liao, Hu Liu, Yibin Zhou, Zhenyu Wang

Institutions: Bengbu Medical College, Zhejiang Chinese Medical University, Shaoxing University

Language: English

Topic: Helicobacter pylori-related gastroenterology studies

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801