A systematic review 1 including 561 studies with a total of 39 614 subjects was abstracted in DARE. Of the studies 369 were RCTs and 660 were open-labelled studies. In the case of nitromidazole resistance, a drop in efficacy of up to 50% was found for bismuth-based triple and proton pump inhibitor-based triple therapies. Four quadruple therapy, a significant difference was found in th equal-effects analysis, but not in the random-effects analysis. In the case of clarithromycin resistance, a mean drop in efficacy of 56% was found for one- and two-week clarithromycin containing proton pump inhibitor-triple therapies and of 58% for two-week ranitidine bismuth citrate combined with clarithromycin therapies. For ranitidine bismuth citrate combined with clarithromycin and nitroimidazole, no difference in efficacy was found in the case of nitroimidazole or clarithromycin resistance, but the data are still scarce.
Comment: The quality of evidence is downgraded by limitations in review methodology.
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