Susceptibility-Guided Therapy vs. Bismuth-Containing Quadruple Therapy as the First-Line Treatment for Infection: A Systematic Review and Meta-Analysis.

Background: The increased antibiotic resistance of () has led to the decreased efficacy of regimens.

Aim: To evaluate the efficacy, safety, and compliance of susceptibility-guided therapy (SGT) vs. bismuth-containing quadruple therapy (BQT) as the first-line treatment for infection.

Materials And Methods: This meta-analysis was performed in accordance with the PRISMA 2009 guidelines. A systematic search in PubMed, Embase, and Cochrane databases was conducted using the combination of " or or ," "bismuth quadruple," and "tailored eradication OR tailored therapy OR susceptibility-guided therapy OR personalized therapy OR antibiotic susceptibility testing."

Results: Five studies with 2,110 infected patients were enrolled. The pooled eradication rates of SGT and BQT were 86 vs. 78% ( < 0.05) and 92 vs. 86% ( > 0.05) by intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. SGT has a significantly superior efficacy than BQT [pooled risk ratio (RR) = 1.14, < 0.05] in a subgroup of cultures with the susceptibility test. The pooled side effect rate was 20% in SGT and 22% in BQT, which showed no significant difference ( > 0.05). The compliances of SGT and BQT were 95 and 92%, respectively.

Conclusion: Compared with BQT, SGT showed a higher efficacy and similar safety as the first-line treatment of infection in areas with high antibiotic resistance. The decision-making of first-line regimens for infection should depend on the availability and cost-effectiveness of susceptibility tests and bismuth in local areas.