- Design
- Systematic review and meta-analysis of 32 randomised trials
- Population
- 4,010 patients receiving H. pylori eradication therapy
- Primary outcome
- Eradication success
- Effect
- RR 1.10 (95% CI 1.05-1.14), NNT 13; adverse events RR 0.70 (0.58-0.84)
This meta-analysis pooled 32 randomised trials with 4,010 patients comparing H. pylori eradication therapy with and without a Lactobacillus supplement.
Lactobacillus raised eradication success (RR 1.10, 95% CI 1.05 to 1.14), so about 13 patients need the supplement for one extra cure. It also reduced treatment-related adverse events (RR 0.70, 0.58 to 0.84). The eradication gain was seen only with triple therapy regimens, not with others, and the reduction in side effects only in adults.
The benefit is modest and strains, doses and timing varied between trials. It does not replace choosing a regimen suited to local clarithromycin resistance, which is high in many regions.
- Consider adding a Lactobacillus supplement when prescribing triple therapy for H. pylori.
- Tell patients it may reduce diarrhoea and other side effects, which helps them complete the course.
- Choose the regimen by local clarithromycin resistance first; the supplement is an adjunct.
- Confirm eradication with a urea breath test or stool antigen test at least four weeks after treatment.
Why it matters
Side effects are a common reason for incomplete courses, and incomplete courses drive failure and resistance.
Don't overread it
The eradication gain was confined to triple therapy; it does not extend to bismuth quadruple or other regimens.
The statistics, in plain English
A relative risk of 1.10 means eradication was about 10% more likely in relative terms. The number needed to treat of 13 means 13 patients receive the supplement for one additional cure. Subgroup findings, such as benefit only with triple therapy, are less reliable than the overall result.
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