Objective To systematically evaluate the efficacy and safety of high-dose dual therapy(HDDT)versus quadruple ther-apy(QT)for the first-line helicobacter pylori(Hp)infection.Methods The randomized controlled trial(RCT)about HDDT versus QT for the first-line treatment of Hp infection were searched from CNKI,VIP,Wanfang,CBM,PubMed,Embase,Cochrane Library and other databases from the establishment of databases to 3 July 2022.RevMan 5.4 and Stata 17.0software were used for Meta-analysis.Results A total of 1l studies with 4015 patients were included.The results of Meta-analysis showed that:the eradication rate of HDDT was statistically superior to that of QT(RR=1.04,95％CI:1.01-1.06,P＜0.01)in the intention-to-treat analysis;the eradica-tion rate of the two groups was not statistically significant(RR=1.02,95％CI:1.00-1.04,P=0.08)in the coincidence protocol a-nalysis.HDDT had a significantly lower rate of adverse reactions than QT(RR=0.47,95％CI:0.36-0.61,P＜0.01);but HDDT and QT both had achieved a similar eradication rate(RR=1.01,95％CI:1.00-1.02,P=0.06)in the per-protocol analysis.Conclusion The efficacy of HDDT in eradicating Hp infection for the first time is better than that of QT,and the safety is better,so it can be used as a first-line treatment in clinic.