The review considered all treatments were tolerable, but 7 days of probiotic supplemented triple treatment and 7 days of levofloxacin based triple treatment ranked best in terms of the proportion of adverse events reported.
According to an editorial, the efficacy of standard triple treatment (7 days of proton pump inhibitor, clarithromycin, and amoxycillin or metronidazole) is falling to unacceptable levels in most countries as antibiotic resistance to clarithromycin and metronidazole increases. However in the UK, which has a low prevalence of clarithromycin resistance (<15%), standard triple treatment is still recommended as empirical first line treatment. The commentator notes that network meta-analysis is most valid when combining similar studies conducted in similar populations, but this is unlikely to be the case for treatment studies from different regions of the world, as H pylori strains from different geographical regions vary widely in their virulence, and the likelihood of resistance to antibiotics. Therefore, network meta-analysis cannot overcome the need to obtain local antibiotic resistance patterns or susceptibility testing before selecting the best available treatment in any particular region.