Efficacy and safety of high‐dose dual therapy for Helicobacter pylori rescue therapy: A systematic review and meta‐analysis

Abstract Objective Although some studies have reported >90% success with high‐dose dual proton pump inhibitor (PPI)–amoxicillin dual therapy for Helicobacter pylori ( H. pylori ) eradication, the efficacy of this therapy remains controversial. We aimed to re‐evaluate the efficacy and safety of high‐dose dual therapy on H. pylori eradication. Methods We searched PubMed, the Cochrane Library, and EMBASE for randomized clinical trials (RCTs) evaluating the efficacy of high‐dose PPI–amoxicillin dual therapy as the rescue therapy on H. pylori eradication. Treatment effect was determined with a fixed‐effect model using the inverse variance method and was expressed as risk ratio (RR) with 95% confidence interval (CI). Results Because of significant statistical heterogeneity (χ 2 15.98, I 2 = 69%) among the six studies that qualified, four RCTs that included 473 patients with H. pylori infection after eradication failure were assessed. The meta‐analysis showed that high‐dose dual therapy and guideline‐recommended rescue therapies achieved similar efficacy (81.3% vs 81.5%, RR 1.00 [95% CI 0.93–1.08], intention‐to‐treat analysis), compliance (95.3% vs 95.4%, RR 1.00 [95% CI 0.97–1.03]), and side effects (17.9% vs 19.7%, RR 0.88 [95% CI 0.62–1.25]). Conclusions High‐dose PPI–amoxicillin dual therapy is comparable to recommended rescue therapies for H. pylori infection. More researches are needed to determine the efficacy of high‐dose dual therapy as a first‐line therapy.