Empirical therapy versus tailored therapy for Helicobacter pylori infection? A systematic review
Abstract
BACKGROUND: The global decline in the efficacy of empirical treatment for Helicobacter pylori eradication driven largely by rising antibiotic resistance has prompted increasing interest in tailored therapeutic approaches. Tailored therapy, guided by antimicrobial susceptibility testing (AST), offers a theoretically superior strategy by enabling selection of effective, resistance-informed regimens. However, the comparative effectiveness of tailored versus empirical therapy remains uncertain across different clinical contexts and geographic regions. MATERIALS AND METHODS: This systematic review was conducted in accordance with PRISMA 2020 guidelines. A comprehensive search of PubMed, Embase, Web of Science, and CENTRAL was performed to identify studies published inception to August 2025 that directly compared empirical and AST-guided tailored therapy for H. pylori eradication. Eligible studies included randomized controlled trials and observational comparative studies reporting intention-to-treat or per-protocol eradication rates. Study selection, data extraction, and risk-of-bias assessments (Newcastle-Ottawa Scale) were performed independently by two reviewers. RESULTS: Fifty-five studies comprising approximately 14,940 patients were included. Tailored therapy demonstrated higher eradication rates in 85% of first-line studies, with PCR-guided regimens achieving the most consistent success. In rescue settings, tailored therapy showed variable outcomes, with several studies…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 14,940 participants or records.
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