As the resistance rate of Helicobacter pylori increases, its recommended eradication regimen continues to evolve. Unless drug susceptibility testing is performed, standard triple therapy (PPI amoxicillin + clarithromycin; PPI amoxicillin + metronidazole) has been completely eliminated. The non-bismuth quadruple regimen (PPI amoxicillin, clarithromycin, and metronidazole) as empiric therapy is also obsolete. Currently, the main recommended regimen for Helicobacter pylori eradication worldwide is quadruple bismuth. Our country has mainly recommended the bismuth quadruple regimen (5 regimens) since 2012, and the recommendation was strengthened in 2017 (2 additional regimens).
Although the bismuth quadruple regimen can still achieve a high eradication rate, the larger number of drugs taken increases the rate of adverse reactions and reduces compliance. In this context, high-dose dual therapy (PPI amoxicillin) has gained renewed attention. At present, the resistance rate of amoxicillin is still very low (0~4). Increasing the strength of acid suppression can significantly improve its antibacterial effect. The second-generation PPI (esomeprazole 20 mg qid or rabeprazole 20 mg qid) amoxicillin (750 mg qid) has an eradication rate of 90% in 2 weeks, and the adverse reaction rate is lower than bismuth quadruple therapy. , can be used as a first-line or remedial solution, and is expected to be recommended in relevant medical knowledge in the future.