El Boury Kenza, Boudarf Hind, Adoud Imane, Ouannass Soukaina, Abi Oussama, Delsa Hanane, Lahlou Fatima Azzahra, Iskandar Samy, El Jemli Meryem, Diawara Idrissa, Senhaji Mohamed Amine, Balouch Lhousaine, Belrhiti Zakaria, Kettani Halabi Mohamed
Research Laboratory in Drug Sciences, Mohammed VI Faculty of Pharmacy, Mohammed VI University of Sciences and Health, Casablanca 82403, Morocco.
Research Unit, Mohammed VI Center for Research and Innovation, Rabat 10112, Morocco.
Antibiotics (Basel). 2025 May 8;14(5):476. doi: 10.3390/antibiotics14050476.
Amoxicillin is one of the most effective antibiotics for treating infections and is widely used in first-line treatment regimens. However, patients with penicillin allergies cannot receive penicillin-based therapies, which significantly limits effective eradication options. This allergy often compels clinicians to choose alternative regimens that may be less effective, thereby increasing the risk of treatment failure. Consequently, therapeutic options for these patients are more restricted, and clinicians must carefully select the most appropriate regimen, taking into account both efficacy and the potential for antimicrobial resistance. This review aims to systematically evaluate the efficacy of penicillin-free treatment regimens for the eradication of in patients with penicillin allergies. Specifically, it seeks to identify, analyze, and synthesize current clinical evidence to determine the most effective alternative therapies, thereby supporting evidence-based clinical decision-making. A literature search was conducted using the PubMed and Scopus databases. We began by reviewing the titles and abstracts of all identified studies to determine eligibility. Next, we assessed the full text of potentially eligible articles according to inclusion and exclusion criteria to establish the eligibility of each study. This review included 26 studies comprising 2713 participants, evaluating penicillin-free therapies for eradication in penicillin-allergic patients. Key findings demonstrated high eradication rates with bismuth-based quadruple therapies (88-97%), doxycycline-based regimens (86%), and quinolone-based therapies (75-100%), with Sitafloxacin exceeding 90% efficacy. Minocycline-based regimens also showed promising outcomes, with eradication rates between 80% and 85%. Although the PPI-clarithromycin-metronidazole combination was moderately effective, it was less favored as a first-line option. Overall, bismuth-based and quinolone-based therapies emerged as the most effective alternatives. In patients allergic to penicillin, bismuth quadruple therapy has demonstrated an excellent rate of eradication. Quinolone-based regimens are emerging as a promising alternative in first-line treatment or in cases of treatment failure. Vonoprazan-based therapy is an effective regimen. Combined with clarithromycin and metronidazole, vonoprazan enhances eradication rates and demonstrates effectiveness, including in clarithromycin-resistant strains.
阿莫西林是治疗感染最有效的抗生素之一，广泛用于一线治疗方案。然而，对青霉素过敏的患者不能接受基于青霉素的治疗，这显著限制了有效的根除方案选择。这种过敏常常迫使临床医生选择可能效果较差的替代方案，从而增加治疗失败的风险。因此，这些患者的治疗选择更加受限，临床医生必须谨慎选择最合适的方案，同时考虑疗效和抗菌药物耐药性的可能性。本综述旨在系统评价不含青霉素的治疗方案对青霉素过敏患者根除幽门螺杆菌的疗效。具体而言，它旨在识别、分析和综合当前的临床证据，以确定最有效的替代疗法，从而支持基于证据的临床决策。使用PubMed和Scopus数据库进行了文献检索。我们首先审查所有已识别研究的标题和摘要以确定其合格性。接下来，我们根据纳入和排除标准评估潜在合格文章的全文，以确定每项研究的合格性。本综述纳入了26项研究，共2713名参与者，评估了不含青霉素的疗法对青霉素过敏患者根除幽门螺杆菌的效果。主要研究结果表明，基于铋剂的四联疗法（88%-97%）、基于多西环素的方案（86%）和基于喹诺酮类的疗法（75%-100%）的根除率较高，其中西他沙星的疗效超过90%。基于米诺环素的方案也显示出有前景的结果，根除率在80%至85%之间。虽然质子泵抑制剂-克拉霉素-甲硝唑联合疗法有一定疗效，但作为一线选择不太受青睐。总体而言，基于铋剂和喹诺酮类的疗法是最有效的替代方案。在青霉素过敏的患者中，铋剂四联疗法已显示出优异的根除率。基于喹诺酮类的方案正在成为一线治疗或治疗失败情况下有前景的替代方案。基于沃克帕唑的疗法是一种有效的方案。与克拉霉素和甲硝唑联合使用时，沃克帕唑可提高根除率并显示出有效性，包括对克拉霉素耐药菌株。
