Is Antimicrobial Susceptibility Testing Necessary Before First-Line Treatment for Helicobacter Pylori Infection? Meta-analysis of Randomized Controlled Trials

Intern Med. 2010;49(12):1103-9. doi: 10.2169/internalmedicine.49.3031. Epub 2010 Jun 15.


Background: With the wide use of antibiotics, antibiotic-resistant Helicobacter pylori strains are becoming increasingly prevalent. It has been hypothesized that culture-guided therapy might help to increase treatment success. But the effects and the costs still remain controversial.

Aims: To systematically review the efficacy and the cost of culture-guided triple therapy, compared to standard triple regimen for first-line treatment of Helicobacter pylori infection.

Methods: A search of the Cochrane Library, PubMed, EMBASE, Science Citation Index Expanded and CBM was performed. Randomized controlled trials comparing culture-guided triple therapy to standard triple therapy in the first-line treatment of Helicobacter pylori infection were selected for meta-analysis. Relative risk was used as a measure of the effect of two regimens mentioned above with a fixed-effects model using the methods of DerSimonian and Laird.

Results: Five randomized controlled trials totaling 701 patients were included. The meta-analysis showed that culture-guided triple therapy was superior referring to a higher eradication rate from intention-to-treat analyses (RR, 0.84; 95% CI,0.77, 0.90; p<0.00001) and a lower overall cost.

Conclusion: Culture-guided triple therapy was more effective than standard triple therapy for first-line treatment of Helicobacter pylori infection. Based on the only paper focused on the overall cost, the culture-guided triple therapy was also more cost saving. Antimicrobial susceptibility testing is necessary before first-line treatment for Helicobacter pylori infection.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Infective Agents / pharmacology
  • Anti-Infective Agents / therapeutic use
  • Drug Resistance, Bacterial / drug effects*
  • Drug Resistance, Bacterial / physiology
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / microbiology
  • Helicobacter pylori / drug effects*
  • Helicobacter pylori / physiology
  • Humans
  • Microbial Sensitivity Tests / methods
  • Randomized Controlled Trials as Topic
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Anti-Infective Agents