Abdulqader Abdulrhman Khaled Al, Alamri Turki Abdullah, Alhamad Mahdi Abdullah, Shehab El-Deen Somaia, Essa Abdallah, Alfayez Raed Abdullah, Albaqshi Baqer Mohammed, Almajed Adnan Salah, Alhassan Mohammed Yousef, Essa Ali, Albadrani Ahmed Abdullah, Alomair Omar, Al Jalal Bashaeer Abdullh, Almulhim Mohammed Yousef, Alotaibi Abdullah, Darwish Ehab
Internal Medicine Department College of Medicine, King Faisal University Al-Ahsa Kingdom of Saudi Arabia.
Internal Medicine Department, Gastroenterology Unit King Fahad University Hospital Al Khobar Kingdom of Saudi Arabia.
Health Sci Rep. 2025 Feb 5;8(2):e70432. doi: 10.1002/hsr2.70432. eCollection 2025 Feb.
Antibiotic resistance in Saudi Arabia has led to decreased efficacy of conventional triple therapy for () eradication, prompting the development of alternative treatments like levofloxacin-based triple and bismuth-based quadruple therapies. However, comparative data regarding its efficacy are lacking. Therefore, this study's goal was to compare the efficacy of levofloxacin-based triple therapy with that of standard bismuth-based quadruple therapy as first-line regimens.
This retrospective analysis included 197 treatment-naïve adults with infection who received levofloxacin-based triple (levofloxacin + amoxicillin + PPI) therapy ( = 81) or standard bismuth-based quadruple (bismuth + tetracycline + metronidazole + PPI) therapy ( = 116). eradication was evaluated 4-8 weeks after medication administration using the C-urea breath test, and variables that could affect the rate of success were examined.
There were no differences between groups in terms of age, sex, nationality, or type of proton pump inhibitor (PPI) used. The bismuth-based quadruple therapy group exhibited a markedly superior success rate compared to the levofloxacin-based triple therapy group when the latter was administered for 7 or 10 days (81.03% vs. 6.66%, < 0.001, and 81.03% vs. 36.1%, < 0.001, respectively). However, when the levofloxacin-based triple therapy was extended to 14 days, its eradication rate became comparable to that of the 10-day bismuth-based quadruple therapy (81.03% vs. 80%, = 0.898). Eradication rates for both regimens were similar for patients aged ≥ 60, non-Saudi, when using omeprazole and those treated with levofloxacin-based triple therapy for 14 days.
Quadruple treatment based on bismuth is superior to triple therapy based on levofloxacin for eradicating in Saudi Arabia and should be used as a first-line treatment. However, the 14-day levofloxacin-based triple treatment had an eradication rate comparable to that of the 10-day bismuth-based quadruple therapy.
沙特阿拉伯的抗生素耐药性导致传统三联疗法根除幽门螺杆菌的疗效下降，促使人们开发基于左氧氟沙星的三联疗法和基于铋剂的四联疗法等替代治疗方案。然而，关于其疗效的比较数据尚缺。因此，本研究的目的是比较基于左氧氟沙星的三联疗法与标准铋剂四联疗法作为一线治疗方案的疗效。
这项回顾性分析纳入了197例初治的幽门螺杆菌感染成人，他们接受了基于左氧氟沙星的三联疗法（左氧氟沙星+阿莫西林+质子泵抑制剂）（n=81）或标准铋剂四联疗法（铋剂+四环素+甲硝唑+质子泵抑制剂）（n=116）。用药后4-8周采用C-尿素呼气试验评估幽门螺杆菌根除情况，并检查可能影响成功率的变量。
两组在年龄、性别、国籍或所用质子泵抑制剂（PPI）类型方面无差异。当基于左氧氟沙星的三联疗法给药7天或10天时，基于铋剂的四联疗法组的成功率明显高于基于左氧氟沙星的三联疗法组（分别为81.03%对6.66%，P<0.001，以及81.03%对36.1%，P<0.001）。然而，当基于左氧氟沙星的三联疗法延长至14天时，其幽门螺杆菌根除率与10天铋剂四联疗法相当（81.03%对80%，P=0.898）。对于年龄≥60岁、非沙特籍、使用奥美拉唑的患者以及接受14天基于左氧氟沙星的三联疗法治疗的患者，两种治疗方案的根除率相似。
在沙特阿拉伯，基于铋剂的四联疗法在根除幽门螺杆菌方面优于基于左氧氟沙星的三联疗法，应作为一线治疗方案使用。然而，14天基于左氧氟沙星的三联疗法的幽门螺杆菌根除率与10天铋剂四联疗法相当。
