This meta-analysis pooled all guideline-recommended, first-line therapies, and considered them to be equivalent to each other. There was a numerical difference in eradication rates achieved with the two different first-line therapies - standard sequential therapies and standard triple therapy – this may have affected the overall pooled results of the analysis. The authors note however that subgroup analyses of fluoroquinolone-based sequential therapy versus standard triple and standard sequential therapies both favoured fluoroquinolone-based sequential therapy, which was consistent with the pooled results.
The authors conclude from their results that fluoroquinolone-based sequential therapy is a reasonable first-line treatment alternative for eradication of H. pylori, and may be a reasonable choice where there is known clarithromycin resistance or when local resistance rates exceed 15%. Therapies should be guided by local antibiotic resistance whenever possible, especially in areas with known prevalence of resistant strains.
Fluoroquinolone use may be associated with the development of Clostridium difficile infections. Although none of the included studies reported this adverse event (AE), only three of the six studies reported AE data, so it is not possible to draw any firm conclusions with respect to comparative safety. The authors comment that the use of fluoroquinolones may result in increased resistance to other gram-negative organisms, thereby limiting their use in other infections, and so they should be used judiciously.