How to choose the treatment plan to eradicate helicobacter pylori by experience?

The Fifth Congress of China recommended seven bismuth-containing quadruple schemes (bismuth +PPI+ two antibiotics), including six antibiotics: amoxicillin, clarithromycin, metronidazole, tetracycline, levofloxacin and furazolidone. The choice of scheme is mainly the choice of antibiotic combination.

At present, the resistance rate of Helicobacter pylori to amoxicillin, tetracycline and furazolidone in China is very low or almost non-resistant, while the resistance rate to clarithromycin, metronidazole and levofloxacin is high or high. There are two kinds of antibiotic combinations with low drug resistance in the recommended scheme, namely, 1 combination with low drug resistance and 1 combination with high drug resistance (bismuth can overcome drug resistance to some extent). After 2 weeks of treatment, the eradication rate was 80%~95% by ITT analysis. In addition to the combined use of antibiotics, the types and doses of PPI and bismuth and the course of treatment will also affect the curative effect.

The following principles can be followed when selecting these schemes through experience: (1) The scheme selection should be based on the balance of curative effect, cost, adverse reactions and drug availability. (2) Routine inquiry about past antibiotic use and history of adverse reactions. Clarithromycin, metronidazole and/or levofloxacin should be avoided as much as possible. (3) Levofloxacin-containing regimen (according to international practice) is not used as first-line treatment; The scheme containing furazolidone is difficult to apply because of the new national regulations on the management of pharmaceutical products (see Part V "Question 17" for details), and other schemes are not divided into first-line and second-line schemes. (4) Those who are not allergic to penicillin should try to choose the scheme containing amoxicillin. A positive skin test for penicillin does not mean that you are allergic to penicillin. Those who have a positive skin test can take another skin test as appropriate. (5) The combination of two antibiotics with low drug resistance rate is easy to obtain a higher eradication rate; However, the curative effect of the combination of low drug resistance rate and high drug resistance rate is not as stable as that of the combination of low drug resistance rate (6) The scheme containing clarithromycin and/or levofloxacin cannot be reused, and the dosage should be optimized when metronidazole is reused (increasing the dosage to 1.6 g/d). (7) The course of treatment should be 14 d as far as possible, unless the related research proves that the eradication rate of 10 d course is ≥90%, especially after the initial treatment fails.