Helicobacter pylori eradication therapy in The Netherlands

Background: Helicobacter pylori cure rates vary in different geographical r egions because of differences in hosts as well as in H. pylori strains. Obj ective: To review systematically all available data in the literature to de termine H. pylori eradication rates in The Netherlands. Methods: A search o f all published trials on H. pylori eradication therapy performed in The Ne therlands was conducted via electronic database search, hand-searching of a bstracts from scientific meetings and checking reference lists of pharmaceu tical companies. Full papers and abstracts were included. Data on anti-H. p ylori therapies were pooled based on duration and combination of drugs. Onl y triple and quadruple eradication regimens were studied. Dual therapies we re excluded, except for ranitidine bismuth citrate-based dual therapies. Re sults: We analysed 38 study arms, involving 2197 patients. Twenty different pooled regimens were studied with a mean intention-to-treat eradication ra te of 83% (range 35-96%). There were no significant differences in the perc entage of patients that stopped treatment due to adverse events between the groups. In these pooled regimens only bismuth combined with tetracycline a nd metronidazole for 1 or 2 weeks was significantly lower in efficacy in me tronidazole-resistant strains than in metronidazole-sensitive strains. The prevalence of metronidazole-resistant strains in The Netherlands showed lar ge regional differences (7-50%). Conclusions: A therapy should be tested in a defined population before becoming standard. Several eradication regimen s studied in The Netherlands yield acceptable cure rates of 80% or more on an intention-to-treat basis. We advise taking the local prevalence of metro nidazole resistance into account when choosing a first-line eradication reg imen.