Ariño Pérez Inés, Martínez-Domínguez Samuel J, Alfaro Almajano Enrique, Carrera-Lasfuentes Patricia, Lanas Ángel
Department of Gastroenterology, Obispo Polanco Hospital, 44002 Teruel, Spain.
Department of Gastroenterology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain.
Antibiotics (Basel). 2022 May 20;11(5):698. doi: 10.3390/antibiotics11050698.
The management and effectiveness of the treatment of infection are heterogeneous worldwide, despite the publication of international consensus conferences and guidelines, which have been widely available for years. The aim of the study was to describe the clinical management and the eradication rates in a region of Southern Europe (Spain). Between 2010 and 2019, we conducted a retrospective analysis of patients with infection attended by gastroenterologists in two defined areas of the National Health System in Aragón. We compared the appropriateness of therapies according to guidelines, and described the effectiveness of each treatment. A total of 1644 penicillin non-allergic patients were included. The most prescribed therapy between 2010 and 2013 was the 'classic' triple therapy PCA (80%), whereas the 'concomitant' therapy PCAM was chosen by 90% of the gastroenterologists in 2015. After 2016, the use of the quadruple bismuth-containing therapy in a single capsule (Pylera) quickly increased, representing almost half of the overall prescriptions in 2019. Throughout the decade, adherence to guidelines was 76.4% and global efficacy was 70.7% (ITT). Triple therapies' eradication rates were lower than 70% (ITT), whereas eradication rates with quadruple therapies achieved or were over 80% (ITT). In conclusion, despite the use of quadruple therapies and optimized treatments, the effectiveness of management in daily clinical practice is far from the target of 90%.
尽管多年来国际共识会议和指南已广泛发布，但全球范围内感染治疗的管理和有效性存在差异。本研究的目的是描述南欧一个地区（西班牙）的临床管理和根除率。2010年至2019年期间，我们对阿拉贡国家卫生系统两个特定地区的胃肠病学家诊治的感染患者进行了回顾性分析。我们根据指南比较了治疗的适宜性，并描述了每种治疗的有效性。共纳入1644例对青霉素不过敏的患者。2010年至2013年最常用的治疗方法是“经典”三联疗法PCA（80%），而2015年90%的胃肠病学家选择了“联合”疗法PCAM。2016年后，单粒含铋四联疗法（Pylera）的使用迅速增加，在2019年占总处方量的近一半。在这十年中，指南依从率为76.4%，总体有效率为70.7%（意向性分析）。三联疗法的根除率低于70%（意向性分析），而四联疗法的根除率达到或超过80%（意向性分析）。总之，尽管使用了四联疗法和优化治疗，但日常临床实践中感染管理的有效性远未达到90%的目标。
