Helicobacter pylori infections are responsible for tremendous morbidity and mortality worldwide, leading to efforts to eradicate the organism. However, the effectiveness of antimicrobial therapy has been undermined by the progressive development of antimicrobial resistance. Treatments and treatment guidelines have been based on traditional pairwise meta-analyses of randomised controlled trials. More recently, network meta-analyses have also been used in an attempt to provide useful information to the clinician regarding which therapies appear best and which to avoid as the least efficacious. However, both forms of meta-analysis have been undermined by the same problems including the poor quality of the clinical trials using unoptimised regimens and incomparable comparisons related to marked geographic and ethnic genotypic and phenotypic heterogeneity. In addition, the comparator regimens often consist of invalid strawman comparisons. New approaches concerning H. pylori treatment and analysis of therapies are needed. H. pylori therapies should be based on antimicrobial stewardship, as in other infectious diseases. This approach requires the use of only optimised therapies proven to be reliably highly effective in the local population (eg, a cure rate of >90%) for both the study and the comparator regimens. Meta-analyses should be restricted to regimens that meet these criteria and must take into account the presence of marked geographical and host genetic and phenotypic heterogeneity. In addition, to provide clinically relevant results, treatment outcomes should focus on, and present, actual cure rates in addition to odd ratios.

中文翻译：

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幽门螺杆菌治疗的荟萃分析和网络荟萃分析的十字路口


幽门螺杆菌感染导致全世界巨大的发病率和死亡率，导致人们努力根除该微生物。然而，抗菌药物耐药性的逐渐发展削弱了抗菌治疗的有效性。治疗和治疗指南基于随机对照试验的传统配对荟萃分析。最近，网络荟萃分析也被用来试图向临床医生提供有用的信息，了解哪些疗法似乎最好，哪些疗法最无效。然而，这两种形式的荟萃分析都受到相同问题的影响，包括使用未经优化的方案进行的临床试验质量差，以及与明显的地理和种族基因型和表型异质性相关的不可比较的比较。此外，比较方案通常由无效的稻草人比较组成。需要有关幽门螺杆菌治疗和治疗分析的新方法。与其他传染病一样，幽门螺杆菌治疗应基于抗菌药物管理。这种方法要求仅使用经证明在当地人群中可靠高效的优化疗法（例如，治愈率 >90%），以用于研究和比较方案。荟萃分析应仅限于满足这些标准的治疗方案，并且必须考虑到明显的地理和宿主遗传和表型异质性的存在。此外，为了提供临床相关的结果，除了奇数比之外，治疗结果还应关注并呈现实际治愈率。