Smith Sinéad M, Nyssen Olga P, FitzGerald Rebecca, Butler Thomas J, McNamara Deirdre, Qasim Asghar, Costigan Conor, Cano-Catalá Anna, Parra Pablo, Moreira Leticia, Megraud Francis, O'Morain Colm, Gisbert Javier P
Trinity Academic Gastroenterology Group (TAGG) Research Centre, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland.
Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain.
Antibiotics (Basel). 2025 Jul 5;14(7):680. doi: 10.3390/antibiotics14070680.
Local audits of () prescriptions and outcomes are necessary to assess guideline awareness among clinicians and treatment effectiveness. The aims were to investigate first-line prescriptions and effectiveness over a 10-year period in Ireland and evaluate the influence of the 2017 Irish consensus guidelines on these trends. Data were collected at e-CRF AEG-REDCap from the European Registry on management (Hp-EuReg) and quality reviewed from 2013 to 2022. All treatment-naïve cases were assessed for effectiveness by modified intention-to-treat (mITT) analysis. Multivariate analysis was also performed. Data from 1000 patients (mean age 50 ± 15 years; 54% female) were analyzed. Clarithromycin (C) and amoxicillin (A) triple therapy represented 88% of treatments, followed by sequential C, A, and metronidazole (M) therapy (4.3%) and triple C + M (2.7%). Bismuth quadruple therapy was prescribed in 1.7% of cases. Treatment durations of 14, 10, and 7 days accounted for 87%, 4.5%, and 8.5% of prescriptions, respectively. High-, standard-, and low-dose proton pump inhibitors (PPIs; 80 mg, 40 mg, and 20 mg omeprazole equivalent b.i.d.) were used in 86%, 0.9%, and 13% of cases, respectively. The overall eradication rate was 80%, while it was 81% for triple C + A. Good compliance and high-dose PPI were associated with higher overall mITT eradication rates (OR 4.5 and OR 1.9, respectively) and triple C + A eradication rates (OR 4.2 and OR 1.9, respectively). Overall eradication rates increased from 74% pre-2017 to 82% ( < 0.05) by the end of 2022. Similarly, the triple C + A eradication rates increased from 76% to 83% ( < 0.05). While first-line treatment effectiveness improved in clinical practice over time, cure rates remain below 90%. Alternative first-line strategies are required in Ireland.
对（）处方和治疗结果进行本地审核对于评估临床医生对指南的知晓情况和治疗效果是必要的。目的是调查爱尔兰10年间的一线处方和疗效，并评估2017年爱尔兰共识指南对这些趋势的影响。数据从欧洲管理登记处（Hp-EuReg）的电子病例报告表（e-CRF）AEG-REDCap中收集，并于2013年至2022年进行质量审核。所有初治病例均通过改良意向性治疗（mITT）分析评估疗效。还进行了多变量分析。对1000例患者（平均年龄50±15岁；54%为女性）的数据进行了分析。克拉霉素（C）和阿莫西林（A）三联疗法占治疗的88%，其次是序贯C、A和甲硝唑（M）疗法（4.3%）以及三联C+M疗法（2.7%）。铋剂四联疗法在1.7%的病例中使用。治疗持续时间为14天、10天和7天的处方分别占87%、4.5%和8.5%。高剂量、标准剂量和低剂量质子泵抑制剂（PPI；分别相当于80毫克、40毫克和20毫克奥美拉唑，每日两次）分别在86%、0.9%和13%的病例中使用。总体根除率为80%，而三联C+A疗法的根除率为81%。良好的依从性和高剂量PPI与更高的总体mITT根除率（分别为OR 4.5和OR 1.9）以及三联C+A根除率（分别为OR 4.2和OR 1.9）相关。总体根除率从2017年前的74%升至2022年底的82%（P<0.05）。同样，三联C+A根除率从76%升至83%（P<0.05）。虽然随着时间推移临床实践中的一线治疗效果有所改善，但治愈率仍低于90%。爱尔兰需要替代的一线治疗策略。
