BACKGROUND AIMS Antibiotic resistance is one of the main factors that determines the efficacy of treatments to eradicate Helicobacter pylori (H. pylori) infection. Our aim was to evaluate the effectiveness of first-line and rescue treatments against H. pylori in Europe according to antibiotics resistance. METHODS Prospective, multicenter, international registry on the management of H. pylori (Hp-EuReg). All infected and culture-diagnosed adult patients registered in AEG-REDCap e-CRD from 2013-2021 were included. RESULTS A total of 2,852 naïve patients with culture results were analyzed. Resistance to clarithromycin, metronidazole and quinolones was 22%, 27% and 18%, respectively. The most effective treatment, regardless of resistance, were the three-in-one single-capsule with bismuth, metronidazole and tetracycline (96%), and the classic bismuth quadruple, offering optimal cure rates even in the presence of bacterial resistance to clarithromycin or metronidazole. The concomitant regimen with tinidazole achieved an eradication rate of 100% (68/68) vs. 73% (44/60) with metronidazole. Triple schedules, sequential or concomitant regimen with metronidazole did not achieve optimal results.A total of 1,118 non-naïve patients were analyzed. Resistance to clarithromycin, metronidazole and quinolones was 49%, 41% and 24%, respectively. The three-in-one single-capsule (87%) and the triple therapy with levofloxacin (85%) were the only ones that provided encouraging results. CONCLUSIONS In regions where the antibiotic resistance rate of H. pylori is high, eradication treatment with the three-in-one single-capsule, the quadruple with bismuth and concomitant with tinidazole are the best options in naïve patients. In non-naïve patients, the three-in-one single-capsule and the triple therapy with levofloxacin provided encouraging results.

中文翻译：

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根据抗生素耐药性评估幽门螺杆菌治疗的有效性。

背景目的抗生素耐药性是决定根除幽门螺杆菌（H. pylori）感染的治疗效果的主要因素之一。我们的目的是根据抗生素耐药性评估欧洲针对幽门螺杆菌的一线治疗和挽救治疗的有效性。方法 关于幽门螺杆菌管理的前瞻性、多中心、国际登记处 (Hp-EuReg)。2013 年至 2021 年在 AEG-REDCap e-CRD 中登记的所有感染和培养诊断的成年患者均包括在内。结果 总共分析了 2,852 名初治患者的培养结果。对克拉霉素、甲硝唑和喹诺酮类药物的耐药率分别为22%、27%和18%。无论耐药性如何，最有效的治疗方法是含有铋、甲硝唑和四环素的三合一单胶囊（96%），以及经典的铋四联剂，即使存在对克拉霉素或抗生素耐药的细菌，也能提供最佳治愈率。甲硝唑。替硝唑联合治疗方案的根除率为 100% (68/68)，而甲硝唑联合治疗方案的根除率为 73% (44/60)。三联方案、序贯或联合甲硝唑治疗方案均未达到最佳结果。总共分析了 1,118 名非初治患者。对克拉霉素、甲硝唑和喹诺酮类药物的耐药率分别为49%、41%和24%。三合一单胶囊（87%）和左氧氟沙星三联疗法（85%）是唯一提供了令人鼓舞的结果的疗法。结论 在H. pylori耐药率较高的地区，三合一单胶囊、铋剂四联合替硝唑联合根除治疗是初治患者的最佳选择。在非初治患者中，三合一单胶囊和左氧氟沙星三联疗法提供了令人鼓舞的结果。