Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, China.
Queen Mary College of Nanchang University, Nanchang, China.
Helicobacter. 2021 Oct;26(5):e12839. doi: 10.1111/hel.12839. Epub 2021 Jul 28.
The decreasing Helicobacter pylori eradication rate and the increasing antibiotic resistance trend are of great concern. Therefore, new and effective therapies are needed for H. pylori infection. We conducted a systematic review and meta-analysis to assess the efficacy and safety of semisynthetic tetracycline regimens in H. pylori treatment.
PubMed, EMBASE, and the Cochrane library were searched. The outcome indicators were the eradication rate, risk ratio (RR, ie, the risk of the semisynthetic tetracycline regimen relative to the control), and 95% confidence interval (95% CI). Controls were patients undergoing any other treatment without semisynthetic tetracycline.
Twenty-three studies with 5240 participants were included. The eradication rates of triple regimens with semisynthetic tetracyclines in most studies were less than 70% in both the intention-to-treat (ITT) and the per-protocol (PP) analyses. The pooled eradication rates of quadruple therapies with doxycycline and controls were 95% and 84% in the PP analyses, respectively. The pooled RR associated with efficacy in the quadruple therapy with doxycycline group compared with the control group was 1.12 (95% CI: 1.04-1.20) in the PP analysis. The pooled RR of side effects in the quadruple therapy with doxycycline group compared with the control group was 1.01 (95% CI: 0.65-1.55).
Seven-day and ten-day quadruple therapy with doxycycline might be an optional first-line therapy. The safety of regimens containing semisynthetic tetracyclines was relatively satisfactory. However, the triple regimen is not recommended.
幽门螺杆菌（H. pylori）根除率的下降和抗生素耐药趋势的增加令人担忧。因此，需要新的有效的治疗方法来治疗 H. pylori 感染。我们进行了系统评价和荟萃分析，以评估半合成四环素方案在 H. pylori 治疗中的疗效和安全性。
检索 PubMed、EMBASE 和 Cochrane 图书馆。结局指标为根除率、风险比（RR，即半合成四环素方案相对于对照组的风险）和 95%置信区间（95%CI）。对照组为接受任何其他不含半合成四环素治疗的患者。
纳入 23 项研究，共 5240 名参与者。在大多数研究中，三联疗法中添加半合成四环素的根除率在意向治疗（ITT）和按方案（PP）分析中均低于 70%。PP 分析中，四联疗法（含多西环素）和对照组的根除率分别为 95%和 84%。PP 分析中，四联疗法（含多西环素）组与对照组相比，疗效的 RR 为 1.12（95%CI：1.04-1.20）。四联疗法（含多西环素）组与对照组相比，不良反应的 RR 为 1.01（95%CI：0.65-1.55）。
7 天和 10 天四联疗法（含多西环素）可能是一种可选的一线治疗方法。含半合成四环素的方案安全性相对满意。但是，不推荐三联疗法。
