Liu Ligang, Nahata Milap C
Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA.
College of Medicine, The Ohio State University, Columbus, OH 43210, USA.
Antibiotics (Basel). 2024 Oct 12;13(10):965. doi: 10.3390/antibiotics13100965.
() infection is a global health concern, affecting approximately two-thirds of the world's population. Standard first-line treatment regimens often fail, necessitating alternative rescue therapies.
This review aims to evaluate the efficacy and safety of newer treatment regimens in patients who have failed initial eradication therapy.
A comprehensive literature search was conducted in PubMed, the Cochrane Library, and Embase. Inclusion criteria were randomized controlled trials (RCTs) published after 2010, involving patients with previous treatment failure and interventions with vonoprazan-based therapy, high-dose PPI-amoxicillin dual therapy (HDDT), or rifabutin-containing triple therapy.
10 RCTs were included. HDDT demonstrated high eradication rates (81.3% to 89.2%), particularly when combined with metronidazole (92.6%), although at an increased frequency of adverse events. Vonoprazan-based regimens achieved comparable or higher eradication rates (83.3% to 89.5%) compared to PPI-based therapies, with similar adverse events. Rifabutin-containing triple therapy showed high efficacy (80.7% to 100%), particularly in patients with a history of multiple treatment failures, and it was associated with lower adverse events compared to bismuth-containing regimens.
HDDT, vonoprazan-based therapy, and rifabutin-based therapy have proven to be effective and safe rescue regimens for treating infection. Additional large-scale randomized studies are needed to determine the optimal doses and durations of these regimens to achieve the highest eradication rate with the lowest incidence of adverse events among patients with refractory infections globally.
（）感染是一个全球健康问题，影响着世界约三分之二的人口。标准的一线治疗方案常常失败，因此需要替代的挽救疗法。
本综述旨在评估在初始根除治疗失败的患者中，新型治疗方案的疗效和安全性。
在PubMed、Cochrane图书馆和Embase中进行了全面的文献检索。纳入标准为2010年后发表的随机对照试验（RCT），涉及既往治疗失败的患者以及基于沃克帕唑的治疗、高剂量质子泵抑制剂-阿莫西林双联疗法（HDDT）或含利福布汀的三联疗法的干预措施。
纳入了10项RCT。HDDT显示出高根除率（81.3%至89.2%），尤其是与甲硝唑联合使用时（92.6%），尽管不良事件发生率有所增加。与基于质子泵抑制剂的疗法相比，基于沃克帕唑的方案实现了相当或更高的根除率（83.3%至89.5%），不良事件相似。含利福布汀的三联疗法显示出高疗效（80.7%至100%），尤其是在有多次治疗失败史的患者中，并且与含铋方案相比，不良事件较少。
HDDT、基于沃克帕唑的疗法和基于利福布汀的疗法已被证明是治疗（）感染的有效且安全的挽救方案。需要更多大规模随机研究来确定这些方案的最佳剂量和疗程，以在全球难治性（）感染患者中实现最高的根除率和最低的不良事件发生率。
