Review: quadruple therapies appear to be more effective than triple therapies for eradicating single-drug-resistant Helicobacter pylori.

M e t h o d s Data sources: MEDLINE (to February 2007) and bibliographies of relevant reviews. Study selection and assessment: Englishor Spanish-language studies evaluating triple or quadruple therapies for eradicating H. pylori in patients who were either all sensitive or all resistant to CTM or NTM. Studies had to include ≥ 4 patients per treatment group with H. pylori infection at baseline. Studies of monotherapy or dual therapies were excluded. 93 randomized controlled trials (RCTs) (n = 10 178) met the selection criteria; 68% of treatment groups came from RCTs, 67% of patients had peptic ulcer disease, and 30% had nonulcer dyspepsia. {Individual study quality indicators were included in the metaregression model as suggested by Greenland.}* Outcomes: Eradication of H. pylori infection.