Review: efficacy and safety of hybrid therapy for Helicobacter pylori infection: a systematic review and meta-analysis

Helicobacter. 2015 Apr;20(2):79-88. doi: 10.1111/hel.12180. Epub 2014 Nov 8.


Objectives: To assess the efficacy and safety of hybrid therapy compared to other pre-existing therapies and to new therapies.

Methods: Through a search of PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and Conference Proceedings Citation Index, two independent reviewers systemically identified randomized, controlled trials that compared hybrid therapy to other pre-existing and new therapies. Dichotomous data were pooled to obtain the relative risk (RR) of the eradication rate, with 95% confidence intervals (CIs).

Results: We identified 6 studies, 5 of which compared hybrid therapy and sequential therapy, and 3 of which compared hybrid therapy and concomitant therapy. Pooled estimates of the 5 randomized controlled trials (RCTs) revealed no significant differences between hybrid therapy and sequential therapy and no evidence of heterogeneity (I(2) = 0%; p = .803), the pooled RRs were 1.02 (95% CI: 0.93-1.12) (intention-to-treat (ITT)), and 1.03 (95% CI: 0.94-1.13) (per protocol (PP)). Pooled estimates of the 3 RCTs showed no significant differences between hybrid therapy and concomitant therapy with no evidence of heterogeneity (I(2) = 0%; p = .967), the pooled RRs were 0.99 (95% CI: 0.89-1.10) (ITT) and 0.99 (95% CI: 0.89-1.10) (PP). No significant differences in adverse events were noted among hybrid therapy, sequential therapy, and concomitant therapy ((RR: 1.13; 95% CI: 0.87-1.48; I(2) = 13.2%; p = .327), (RR: 0.89; 95% CI: 0.73-1.08; I(2) = 0%; p = .978) (ITT), respectively). After consideration of all treatment arms, the ITT eradication rates with hybrid therapy, concomitant therapy, and sequential therapy were 88.6, 86.3, and 84.7%, respectively. And the PP eradication rates were 92.1, 92.5, and 87.5%. No significant differences were observed between the groups in terms of compliance.

Conclusions: All three of these therapies yielded good eradication rates. Hybrid therapy could be an alternative to sequential therapy and concomitant therapy, but additional RCTs are needed to confirm this finding.

Keywords: H. pylori; drug therapy; eradication.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Amoxicillin / adverse effects
  • Amoxicillin / therapeutic use
  • Anti-Infective Agents / adverse effects*
  • Anti-Infective Agents / therapeutic use*
  • Bismuth / adverse effects
  • Bismuth / therapeutic use
  • Clarithromycin / adverse effects
  • Clarithromycin / therapeutic use
  • Drug Therapy, Combination / adverse effects
  • Drug Therapy, Combination / methods
  • Helicobacter Infections / drug therapy*
  • Humans
  • Metronidazole / adverse effects
  • Metronidazole / therapeutic use
  • Proton Pump Inhibitors / adverse effects*
  • Proton Pump Inhibitors / therapeutic use*
  • Randomized Controlled Trials as Topic
  • Treatment Outcome


  • Anti-Infective Agents
  • Proton Pump Inhibitors
  • Metronidazole
  • Amoxicillin
  • Clarithromycin
  • Bismuth