Shih Chih-An, Wu Deng-Chyang, Shie Chang-Bih, Hsu Ping-I
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Antai Medical Care Corporation, Antai Tian-Sheng Memorial Hospital, Pingtung County 928004, Taiwan.
Department of Nursing, Meiho University, Pingtung County 912009, Taiwan.
Microorganisms. 2025 Mar 21;13(4):715. doi: 10.3390/microorganisms13040715.
Due to the increasing prevalence of antimicrobial resistance, the efficacy of standard triple therapy for () infection has declined, with eradication rates now falling below 80% in most countries. Although bismuth quadruple therapy and concomitant therapy are advised in regions with high clarithromycin resistance, these treatments commonly cause frequent adverse events and require the use of two or three antibiotics. This review article evaluates the effectiveness of 14-day mono-antibiotic therapies for infection through randomized controlled trials conducted from 1 October 2014 to 1 October 2024. The pooled eradication rates for 14-day high-dose amoxicillin/proton pump inhibitor (PPI) dual therapies were 86.1% (3335/3875; 95% confidence interval (CI): 85.1-87.2%) by intention-to-treat (ITT) analysis and 87.3% (3232/3702; 95% CI: 86.2-88.4%) by per-protocol (PP) analysis. For 14-day high-dose amoxicillin/vonoprazan dual therapies, the rates were 87.4% (1085/1241; 95% CI: 85.5-89.2%) by ITT and 93.0% (1044/1124; 95% CI: 91.5-94.5%) by PP. In the penicillin-allergic population, 14-day tetracycline/vonoprazan dual therapy showed eradication rates of 92.0% (138/150) by ITT and 95.1% (135/142) by PP. In conclusion, 14-day tetracycline/vonoprazan dual therapy presents an effective option for eradicating in patients allergic to penicillin. For those without a penicillin allergy, first-line treatments can include 14-day mono-antibiotic regimens, such as high-dose amoxicillin/PPI dual, high-dose amoxicillin/vonoprazan dual, and tetracycline/vonoprazan dual therapies.
由于抗菌药物耐药性的日益普遍，标准三联疗法对（）感染的疗效有所下降，目前在大多数国家根除率已降至80%以下。尽管在克拉霉素耐药率高的地区建议使用铋剂四联疗法和联合疗法，但这些治疗通常会频繁引起不良事件，并且需要使用两种或三种抗生素。这篇综述文章通过2014年10月1日至2024年10月1日进行的随机对照试验，评估了14天单一抗生素疗法对（）感染的有效性。意向性分析（ITT）显示，14天高剂量阿莫西林/质子泵抑制剂（PPI）双联疗法的合并根除率为86.1%（3335/3875；95%置信区间（CI）：85.1-87.2%），按符合方案分析（PP）为87.3%（3232/3702；95%CI：86.2-88.4%）。对于14天高剂量阿莫西林/沃克奥美拉唑双联疗法，ITT分析的根除率为87.4%（1085/1241；95%CI：85.5-89.2%），PP分析为93.0%（1044/1124；95%CI：91.5-94.5%）。在青霉素过敏人群中，14天四环素/沃克奥美拉唑双联疗法的ITT根除率为92.0%（138/150），PP根除率为95.1%（135/142）。总之，14天四环素/沃克奥美拉唑双联疗法是根除青霉素过敏患者（）的有效选择。对于那些没有青霉素过敏的患者，一线治疗可包括14天单一抗生素方案，如高剂量阿莫西林/PPI双联、高剂量阿莫西林/沃克奥美拉唑双联和四环素/沃克奥美拉唑双联疗法。
