Eradication efficacy of empiric bismuth quadruple therapy containing amoxicillin in the first-line treatment of Helicobacter pylori in Ningxia, China

Eradication efficacy of empiric bismuth quadruple therapy containing amoxicillin in the first-line treatment of Helicobacter pylori in Ningxia, China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Eradication efficacy of empiric bismuth quadruple therapy containing amoxicillin in the first-line treatment of Helicobacter pylori in Ningxia, China Xiaoming Su, Xianmei Chen, Yanling Li, Yuanyuan Tang, Rui Mu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6363050/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Mar, 2026 Read the published version in BMC Gastroenterology → Version 1 posted 12 You are reading this latest preprint version Abstract OBJECTIVE: The objective was to evaluate the eradication rate and safety of bismuth quadruple therapy containing amoxicillin in the first-line empiric treatment in with high resistance to Helicobacter pylori ( H. pylori ) in China. METHODS: This was a retrospective study of 874 H.pylori -infected patients who attended the outpatient clinic of the Department of Gastroenterology of the People's Hospital of Ningxia Hui Autonomous Region from June 2021 to October 2022 and met the criteria for exclusion, including Esomeprazole-Bismuth-Amoxicillin-Clarithromycin (EBAC) group, Esomeprazole-Bismuth-Amoxicillin-Levofloxacin (EBAL) group, Esomeprazole-Bismuth-Amoxicillin-Furazolidone (EBAF) group, Esomeprazole-Bismuth-Amoxicillin-Tetracycline (EBAT) group, and the duration of treatment was 14 days. Eradication of H. pylori was determined by a repeat 14-carbon urease breath test (14C-UBT) at weeks 4-6 after the end of treatment. RESULTS: In the intention-to-treat analysis (ITT), the eradication rates of H. pylori in the EBAC, EBAL, EBAF, and EBAT groups were 74.2% (201/271), 75.4% (202/268), 82.9% (126/152), and 74.3% (136/183), respectively; and in the per-protocol (PP) analysis, the PP analysis eradication rates were 83.0% (201/245), 84.9%(202/238), 91.3%(126/138), and 82.4% (136/165), and the differences in the eradication rates of the four groups for ITT and PP analysis were not statistically significant (ITT: P = 0.186; PP: P = 0.086). The incidence rates of adverse event(AE) in the EBAC, EBAL, EBAF and EBAT groups was 13.9% (34/245), 8.4% (20/238), 24.0% (33/138) and 29.7% (49/165), respectively, with a statistically significant difference ( P < 0.001). Conclusion: The efficacy of the amoxicillin-containing regimens in the EBAC, EBAL, EBAT and EBAF groups in Ningxia, China, was similar, and all of them can be used for first-line treatment of H.pylori in this region, and the incidence of adverse effects of furazolidone and tetracycline should be monitored. Helicobacter pylori quadruple therapy eradication rate Introduction Helicobacter pylori ( H. pylori ) is a gastric Gram-negative, helical, microaerophilic pathogen, which is closely related to the development of chronic gastritis, peptic ulcer, gastric mucosa-associated lymphoid tissue lymphoma, and gastric cancer, in addition to the occurrence of some non-intestinal diseases, such as idiopathic thrombocytopenic epilepsy and iron deficiency anemia. In 1994, the World Health Organization classified H. pylori as a class I carcinogen, which is the only prokaryotic pathogenic microorganism classified as a carcinogen [1, 2, 3], and the Kyoto global consensus report on H. pylori gastritis recommended that should be treated in patients with H. pylori infection, regardless of clinical symptoms. infection should be treated with eradication therapy regardless of the presence or absence of clinical symptoms [3]. Currently, with the widespread development of H. pylori eradication therapy, as well as the diversification of eradication protocols, the widespread use of antibiotics has led to an increase in resistance to H. pylori worldwide, especially Metronidazole, Levofloxacin, Clarithromycin, the eradication rate of bismuth quadruple therapy with the increase in antibiotic resistance and the tendency to decrease, and there are even reports that bismuth quadruple therapy containing Clarithromycin or Levofloxacin has been reported to reduce the rate of eradication of H.pylori infection. The eradication rate of bismuth quadruple therapy is less than 80% [4, 5], but the incidence rate of adverse effects of bismuth quadruple therapy is still high [6, 7], especially those containing Furazolidone or Tetracycline.Increased resistance of H. pylori to antibiotics is believed to be the main reason for the failure of eradication [8, 9]. Information on antibiotic resistance is important in guiding the treatment of H. pylori if obtained prior to treatment. Relevant studies have shown that treatment guided by drug resistance detection is comparable to or even better than empirical quadruple therapy [10, 11, 12, 13], and triple therapy can also achieve an eradication rate of more than 90% [14], especially in areas with high antibiotic resistance [15], or in patients who have failed previous eradication therapy [16]. However, resistance-detection-guided therapy has some limitations in clinical practice, mainly due to the low detection rate of H. pylori , the harsh experimental conditions for bacterial culture, the long incubation period, and the high cost of treatment, especially in areas with high rates of H. pylori infection and drug resistance, and where healthcare resources are scarce. Due to the obvious geographical differences in the infection and drug resistance rates of H. pylori , according to the national multicenter data from the China H. pylori Molecular Medicine Center Surveillance in 2021, the resistance rates of Metronidazole, Clarithromycin, and Levofloxacin were 87.8%, 37.0%, and 34.2%, respectively [17]. Surprisingly, in the face of such a severe regional resistance challenge, several current studies have reported that the resistance rate of H. pylori to amoxicillin remains low [5, 6, 7, 17], and its low incidence of adverse events during eradication therapy and its reusability have made amoxicillin gradually become the antibiotic of choice for a wide range of therapeutic regimens. H. pylori infections and drug resistance in the Ningxia region of China in the period 2020-2022, epidemiologic screening for H. pylori infection and resistance showed resistance rates to Metronidazole, Levofloxacin, Clarithromycin, Amoxicillin, Tetracycline, and Furazolidone of 94.2%, 42.4%, 40.4%, 0.9%, 0.3%, and 0.1%, respectively [18]. Therefore, with a clear background of regional antibiotic resistance, the selection of appropriate antibiotics and a reliable treatment regimen is instructive for the first-line treatment of H. pylori , and the aim of our study was to evaluate the eradication efficacy of empirical bismuth containing amoxicillin in the first-line treatment of H. pylori . Materials and Methods Study design and subjects This was a retrospective study in which participants who attended the outpatient clinic of the Department of Gastroenterology of the People's Hospital of Ningxia Hui Autonomous Region with upper gastrointestinal symptoms from June 2021 to October 2022 were selected to undergo the 14-carbon urease breath test (14C-UBT), and participants with a positive result of the 14C-UBT and meeting the exclusion criteria, and the inclusion criteria were included in this study. All participants signed an informed consent form before participating in this trial. The study protocol was approved by the Ethics Committee of Ningxia Hui Autonomous Region People's Hospital (2022LW006) and followed the Declaration of Helsinki. Questionnaires included: gender, age, smoking, alcohol consumption, education level, monthly income (RMB), living area, communal utensils, history of previous antibiotic use. Inclusion criteria Participants who were positive for H. pylori by 14C-UBT, those who were in the age range of 18-75 years, those who were not taking proton pump inhibitors (PPI), bismuth, antibiotics, and non-steroidal drugs in the 4 weeks prior to performing 14C-UBT. Exclusion criteria : participants are less than 18 years old, participants with a clear diagnosis of gastrointestinal tumors or a previous history of a major gastric resection, undergoing radiation or chemotherapy, allergic to or intolerant of medications, pregnant or breastfeeding; participating in other clinical trials. Treatment regimen and observation indexes The dosage and frequency of the base drugs of the bismuth quadruple therapy regimen were Esomeprazole(E) 20mg twice daily, Bismuth(B) agent 220mg twice daily, Amoxicillin(A) 1000mg twice daily, and the duration of treatment was 14 days, including EBAC group: EAB+clarithromycin(C) 500mg twice daily; EBAL group: EAB+levofloxacin(L) 200mg twice daily; EBAF group: EAB+furazolidone(F) 100mg twice daily;EBAT group: EAB+tetracycline(T) 500mg four times daily. Esomeprazole and bismuth were administered orally 30 minutes before a meal. Antibiotics except tetracycline were administered 30 minutes after a meal, and tetracycline was administered 2 hours after a meal. The outcome indicator of this study was eradication rate, participants were retested for 14C-UBT at weeks 4-6 after the end of treatment, and the result was negative suggesting that H. pylori eradication was successful, eradication rate (%) = [number of cases with negative 14C-UBT retests after eradication treatment/number of cases receiving H. pylori eradication treatment]. Statistical analysis SPSS 23.0 was used to statistically analyze the entered data, and the count data were expressed as percentage (%), and the chi-square test was used, and the difference was considered to be statistically significant when P -value <0.05, and the treatment results would be analyzed using the Intention-to-treat (ITT) analysis and the Follow the research protocol (Per-Protocol, PP) analysis. The analysis of relevant influencing factors was expressed using Diagnostic odds ratio (OR) values, and differences were considered statistically significant when the upper limit of the 95% confidence interval (CI) was less than 1 or the lower limit was greater than 1. Results Empirical treatment regimen eradication rate A total of 874 patients who met the exclusion criteria were included in this study, and the overall empirical bismuth quadruple therapy eradication rates for the ITT analysis and PP analysis were 76.3% (665/874; 95%CI 73.5-79.2), 84.6% (665/786; 95%CI 82.1 -87.1). Among 271 cases in the EBAC group, the eradication rates of ITT analysis and PP analysis were 74.2% (201/271; 95%CI 68.9-79.4) and 82.0% (201/245; 95%CI 77.2-86.9), respectively; and among 268 cases in the EBAL group, the eradication rates of ITT analysis and PP analysis were 75.4% ( 202/268; 95%CI 70.2-80.6), 84.9% (202/238; 95%CI 80.3-89.5); in 152 cases in the EBAF group, the eradication rates of ITT analysis and PP analysis were 82.9% (126/152; 95%CI 76.8-88.9) and 91.3% (126/138; 95%CI 86.5-96.1); 183 patients were included in the EBAT group, with eradication rates of 74.3% (136/183; 95%CI 67.9-80.7) and 82.4% (136/165; 95%CI 76.6-88.3) for the ITT and PP analyses, respectively. None of the above differences in the eradication rates of ITT and PP analyses among the different treatment groups were statistically significant(ITT: c=4.809, P =0.186; PP: c=6.608, P =0.086), Table 1. Table 1. Comparison of ITT and PP analysis eradication rates in different treatment groups. EBAC EBAL EBAF EBAT P ITT 74.2%(201/271) 75.4%(202/268) 82.9%(126/152) 74.3%(136/183) 0.186 95%CI 68.9-79.4 70.2-80.6 76.8-88.9 67.9-80.7 PP 82.0%(201/245) 84.9%(202/238) 91.3%(126/138) 82.4%(136/165) 0.086 95%CI 77.2-86.9 80.3-89.5 86.5-96.1 76.6-88.3 Effect of demographic and clinical factors on eradication rates Demographic and clinical factors affecting eradication rates in the EBAC group, EBAL group, EBAF group and EBAT group were compared among the patients analyzed in PP, and it was found that the eradication rate of H.pylori was lower in the subjects living in rural areas than in city areas in both the EBAC group and EBAL group (EBAC: 77.7% vs. 87.7%; EBAL : 83.6% vs. 93.2%). (EBAC: 77.7% vs. 87.7%; EBAL: 83.6% vs. 93.2%), and the difference in eradication rates between the two was statistically significant (OR 95% CI upper limit less than 1); in the EBAC group and EBAL group, subjects with previous amoxicillin use (6 months prior to receiving eradication therapy) had lower H. pylori eradication rates than subjects living in cities. The eradication rate of H. pylori was lower than that of subjects with no prior use of amoxicillin (EBAC: 89.0% vs. 78.5%; EBAL: 89.9% vs. 80.6%), and the differences in the eradication rates between the two groups were statistically significant (lower limit of the 95% CI of the OR value was greater than 1). Factors such as gender, education level, monthly income level, smoking, alcohol, sharing of tableware and cups had no effect on the eradication rate of H.pylori. Table 2. Table 2. Effect of demographic and clinical factors on eradication rates of different treatment regimens. EBAC EBAL EBAF EBAT Gender Female 109(82.0) 105(89.7) 147(92.5) 70(84.3) Male 95(84.8) 21(100.0) 69(87.3) 66(80.5) OR(95%CI) 0.813(0.412-1.603) 0.897(0.844-0.954) 1.775(0.732-4.309) 1.305(0.583-2.921) Education level Junior 72(80.9) 41/(95.3) 134(93.1) 62(83.8) Senior 132(84.6) 85(89.5) 82(87.2) 74(81.3) OR(95%CI) 0.770(0.388-1.527) 2.412(0.505-11.515) 1.961(0.811-4.742) 1.187(0.527-2.674) Monthly income(RMB) 5000 61(88.4) 11(78.6) 34(87.2) 71(81.6) OR(95%CI) 0.568(0.248-1.301) 3.485(0.821-14.792) 1.574(0.544-4.554) 1.127(0.504-2.521) Living region Rural 108(77.7) 92(83.6) 66(90.4) 58(82.9) City 93(87.7) 110(93.2) 60(92.3) 78(82.1) OR(95%CI) 0.487(0.241-0.985) 0.372(0.155-0.894) 0.786(0.237-2.608) 1.053(0.467-2.376) Used amoxicillin No 73(89.0) 98(89.9) 49(90.7) 52(88.1) Yes 128(78.5) 104(80.6) 77(91.7) 84(87.5) OR(95%CI) 2.218(1.010-4.872)* 2.142(1.001-4.584)* 0.891(0.268-2.965) 1.061(0.393-2.868) Smoking No 136(83.4) 18(90.0) 108(92.3) 54(83.1) Yes 68(82.9) 101(87.1) 18(85.7) 82(82.0) OR(95%CI) 1.037(0.551-2.105) 1.034(0.518-2.062) 2.000(0.494-8.100) 1.078(0.472-2.459) Alcohol No 142(84.5) 105/(92.1) 173(90.1) 96(82.1) Yes 62(80.5) 21(87.5) 43(93.5) 40(83.3) OR(95%CI) 1.321(0.655-2.666) 1.667(0.416-6.679) 0.635(0.180-2.425) 0.914(0.374-2.235) Shared tableware Sometimes 73(88.0) 80(92.0) 42(87.5) 50(84.7) Regular 131(80.9) 46(90.2) 174(91.6) 86(81.1) OR(95%CI) 1.727(0.801-3.724) 1.242(0.373-4.139) 0.644(0.238-1.744) 1.292(0.546-3.055) Shared water cup Sometimes 186(83.0) 106(90.6) 196(90.7) 106(83.5) Regular 18(85.7) 20(95.21) 20(90.9) 30(78.9) OR(95%CI) 0.816(0.229-2.908) 0.482(0.059-3.943) 0.980(0.213-4.502) 1.346(0.542-3.343) Note:*: P < 0.05 Comparison of adverse events between empiric therapy The incidence of adverse events of EBAT, EBAF, EBAC and EBAL group was 29.7%, 24.0%, 13.9%, 8.4%, 7.7%, respectively. Notably, the incidence of adverse reactions was significantly different among the groups (c=52.900, P <0.001), and the difference between mild and moderate adverse events in the empiric treatment group was significant (c=16.499, P =0.002; c= 44.280, P <0.001), Table 3. Table 3. Adverse events of each empiric treatment regimen. EBAC EBAL EBAF EBAT P %(n) 34(13.9) 20(8.4) 33(24.0) 49(29.7) <0.001 AE level Mild 26(10.6) 18(7.6) 20(14.5) 30(18.2) 0.002 Moderate 8(3.3) 2(0.8) 13(9.5) 19(11.5) <0.001 Severe 0 0 0 0 AE Nausea 7(2.9) 8(3.4) 1(0.7) 9(5.5) Vomiting 3(1.2) 2(0.8) 0 5(3.0) Abdominal pain 6(2.4) 1(0.4) 5(3.6) 8(4.8) Abdominal distension 15(6.1) 2(0.8) 14(10.1) 14(8.5) Diarrhea 1(0.4) 0 3(2.2) 6(6.1) Skin rash 2(0.8) 0 0 3(1.8) Headache 0 5(2.1) 1(0.7) 2(1.2) Dizzy 0 2(0.8) 0 2(1.2) Discussion H.pylori is a Gram-negative, helical, microaerophilic pathogen that has infected more than 50% of the population worldwide due to its ability to resist the acidic gastric environment [19-21]. H.pylori infection has been associated not only with different digestive disorders such as gastritis, peptic ulcer, mucosa-associated lymphoid tissue lymphoma, and gastric adenocarcinoma, but also with the development of iron deficiency anemia, vitamin B12 deficiency, and idiopathic thrombocytopenic purpura [22]. The population is generally susceptible to H. pylori , and the 2015 Tokyo Global Consensus Report recommends that for H.pylori -infected individuals, regardless of the presence or absence of clinical symptoms, they should receive eradication therapy, and the current domestic and international consensus opinions recommend bismuth quadruple therapy as a first-line treatment regimen for H.pylori [3, 4, 5], but with the widespread eradication of H. pylori bismuth quadruple regimen eradication rates have been on a downward trend, H.pylori increased resistance to antibiotics is considered to be the main reason for eradication failure, and resistance regarding H.pylori has become an inevitable challenge in eradication treatment, therefore, selecting appropriate antibiotics and treatment regimens for first-line empirical treatment in areas with high rates of H.pylori infection and resistance can provide some reference for localized eradication of H.pylori . Our findings showed that the eradication rates in the empirical bismuth quadruple therapy treatment groups were 76.3% (665/874; 95% CI 73.5-79.2), 84.6% (665/786; 95% CI 82.1-87.1), respectively, with the highest eradication rates in the EBAF group, with eradication rates analyzed by ITT, PP, of 82.9% (126/152; 95% CI 76.8-88.9), and 91.3% (126/138; 95% CI 86.5-96.1), respectively. The current resistance rate to furazolidone is low (<5%), and studies have shown that furazolidone-containing regimens can achieve better efficacy compared to other empirical bismuth quadruple regimens of the same duration [23]. A retrospective study showed a 95.3% primary eradication rate for bismuth quadruple therapy containing amoxicillin in combination with furazolidone [24]. In addition, a Meta-analysis of the eradication efficacy of furazolidone showed that the furazolidone-containing regimen was more efficacious than other antibiotic regimens of the same duration of treatment in terms of eradication rate (ITT: 81.1% vs. 75.4%, PP: 86.6% vs. 80.1%), with no significant increase in adverse effects (<10%) [25]. However, the results of Niu M's study showed that the PP eradication rate of bismuth quadruple regimen containing furazolidone with a course of 14 days was 94.7%, but had a high incidence of adverse reactions (24.8%) compared to the other treatment regimens [26]. The EBAF group in this study had a higher ITT and PP eradication rate analyzed than the empirical EBAC, EBAL and EBAT groups, but the efficacy was not superior to the other bismuth quadruple therapy groups. As with EBAT group, the incidence of AEs was more than 20%, and the grade of AEs in both groups was mainly "mild", and the high incidence of adverse effects might be one of the reasons affecting the eradication effect of the furazolidone and tetracycline regimen. The incidence of adverse effects of furazolidone is related to the dosage and duration of administration [23], and tetracycline may cause significant hepatic and renal impairment, so the use of furazolidone should be done under the guidance of a clinician, and the occurrence of adverse effects should be monitored, and the use of tetracycline should be monitored for the same reason. The results of the present study showed a poor eradication rate in the clinically used EBAC and EBAL groups (ITT: 74.2% vs. 75.4%; PP: 83.0% vs. 84.9%), which is generally consistent with the results of other studies [23-25]. In the EBAC and EBAL groups, the eradication rate of H.pylori in patients living in rural areas was lower than that in urban populations, which may be related to the high prevalence of H.pylori infection in rural areas, poorer healthcare and hygiene, weaker personal health awareness, and fewer clinical antimicrobial drug choices. Amoxicillin, clarithromycin and levofloxacin are widely used antibiotics in clinical practice, and the three are often applied in the treatment of infectious diseases outside the gastrointestinal tract, especially in the respiratory system and inflammatory diseases in the urinary system, and there are characteristics of inflammation in the urinary system and pneumonia that are easy to recur and require multiple treatments, which may be due to the indirect application of clarithromycin and levofloxacin in infectious diseases outside the gastrointestinal tract in terms of the course of treatment, type and frequency of medication has not yet reached the eradication of H.pylori and is associated with the increase of H.pylori resistance due to the accumulation of antimicrobial drugs over time [27], but of course the mechanism of this increase of H.pylori resistance due to the accumulation of antimicrobial drugs over time still needs to be confirmed by further studies. Related studies analyzing antibiotic consumption in Europe showed a significant association between macrolide use and H.pylori resistance to clarithromycin, and a significant association between quinolone use and levofloxacin resistance [28]. The results of Kwon's study were consistent with this finding and showed that a history of macrolide and quinolone use was associated with a decrease in the eradication rate of bismuth tetracycline containing clarithromycin, and levofloxacin containing bismuth, respectively [29]. The results of this study showed that previous use of amoxicillin affected the eradication of H.pylori , and according to the 2020-2022 study of H.pylori resistance in Ningxia, the resistance rate of metronidazole in this region was 94.2%, that of both clarithromycin and levofloxacin was more than 40%, and that of tetracycline and furazolidone was less than 5%, and that the rate of multi-drug resistance was 24.2%. In the face of such a severe resistance challenge, the use of potentially resistant clarithromycin and levofloxacin for the eradication of H.pylori in the absence of clarity about resistance at the time of eradication greatly increases the risk of treatment failure, and this risk of treatment failure due to a high rate of single resistance or an increase in the rate of multi-resistance may be more pronounced in patients with prior amoxicillin use. However, our results show that prior amoxicillin use did not significantly affect H.pylori eradication rates in the EBAF and EBAT groups, and perhaps the use of furazolidone and tetracycline, which have lower resistance rates (<5%), may overcome the adverse effects of prior amoxicillin use to some extent. The eradication rate of empirical bismuth quadruple therapy containing amoxicillin in this region ranged from 74.2%-82.9% in ITT analysis and 82.0%-91.3% in PP analysis, and overall the eradication rate of bismuth quadruple therapy containing amoxicillin was poor in this region and the eradication rate was affected by the history of previous medication with amoxicillin, especially in the clarithromycin and levofloxacin groups. Obviously, in the face of the dilemma of high H.pylori resistance to metronidazole, clarithromycin, and levofloxacin, and poor eradication rate of bismuth quadruple therapy in this region, the overall downward trend of first-time eradication success rate has not been effectively controlled despite the increasing variety of combinations of the consensus-recommended H.pylori eradication regimen and the increasing duration or dosage of the regimens, and it would be helpful to obtain pre-treatment antibiotic The availability of antibiotic resistance information prior to treatment can positively guide the eradication of H.pylori . Several scholars have shown that individualized treatment based on drug sensitivity analysis is more effective than empirical treatment with the same course of treatment [9-13], especially in areas with high antibiotic resistance rates [15]. Individualized treatment guided by the results of drug sensitivity test before treatment can achieve better eradication results and can promote the rational application of antibiotics, which may be an effective way to improve the eradication rate of H.pylori in Ningxia, China. Therefore, we will evaluate the efficacy and safety of individualized bismuth quadruple therapy guided by resistance detection in subsequent studies. This study still has some limitations, this study is a retrospective study, some of the data may have some bias; 2) it is not comprehensive enough in the collection of clinical data, and did not include the previous use of clarithromycin, levofloxacin, furazolidone, and tetracycline, which resulted in the unclear effect of the above medications on the corresponding treatment regimen, in the EBAT group, 10 participants were unable to provide accurate information about the past use of amoxicillin, which may affect the analysis and discussion of the results in this group; 3) this study is a regional single-center study, with a small amount of sample data, and a multicenter study is needed to expand the sample size in the follow-up. Conclusion EBAC, EBAL, EBAT, and EBAF regimens containing amoxicillin have similar efficacy in the Ningxia region of China, and all of them can be used for first-line treatment of H.pylori in this region, and the incidence of adverse effects of furazolidone and tetracycline should be monitored in the eradication treatment. Abbreviations H. Pylori Helicobacter pylori 14C-UBT 14-carbon urease breath test ITT Intention-to-treat analysis PP Per-protocol AE Adverse event OR Odds ratio CI Confidence interval PPI Proton pump inhibitor E Esomeprazole B Bismuth A Amoxicillin C Clarithromycin L Levofloxacin F Furazolidone T Tetracycline Declarations Ethics approval and consent to participate The study protocol was approved by the Ethics Committee of Ningxia Hui Autonomous Region People's Hospital (2022LW006) and followed the Declaration of Helsinki. All participants signed an informed consent form before participating in this trial. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare no competing interests. Fundings Many thanks to the governmental departments and various hospitals in Ningxia Hui Autonomous Region for providing support and assistance in conducting this study. This study was supported by the Key Research and Development Program of Ningxia Hui Autonomous Region (No. 2021BEG02025), and the Key scientific and technological achievements transformation projects of Ningxia Hui Autonomous Region (No. 2024CJE09045). Authors’ contributions SXM and HSJ designed the experiment. CXM, TYY, WYT and LYL conducted the experiment. SXM analysed the samples and performed data analysis. SXM produced the first draft of the manuscript and HSJ contributed to drafting and editing the manuscript. All the authors have read and approved the final version of the manuscript. Acknowledgements Not applicable. Author details 1 The Fifth People's Hospital of Ningxia Hui Autonomous Region , Shizuishan 753000, China. 2 People's Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People's Hospital of Ningxia Autonomous Region), Yinchuan 750000, China. References Sugano K, Tack J, Kuipers EJ, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut . 2015;64(9):1353-1367. doi:10.1136/gutjnl-2015-309252 Graham DY, Lu H, Yamaoka Y. A report card to grade Helicobacter pylori therapy. 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Antimicrobial Susceptibility-Guided Therapy Versus Empirical Concomitant Therapy for Eradication of Helicobacter pylori in a Region with High Rate of Clarithromycin Resistance. Helicobacter . 2016;21(1):29-34. doi:10.1111/hel.12231 Costa, Samuel et al. “Efficacy and tolerability of culture-guided treatment for Helicobacter pylori infection.” European journal of gastroenterology & hepatology vol. 29,11 (2017): 1258-1263. doi:10.1097/MEG.0000000000000960 Wenzhen Y, Yumin L, Quanlin G, et al. Is antimicrobial susceptibility testing necessary before first-line treatment for Helicobacter pylori infection? Meta-analysis of randomized controlled trials. Intern Med . 2010;49(12):1103-1109. doi:10.2169/internalmedicine.49.3031 Cammarota G, Ianiro G, Bibbò S, et al. Culture-guided treatment approach for Helicobacter pylori infection: review of the literature. World J Gastroenterol . 2014;20(18):5205-5211. doi:10.3748/wjg.v20.i18.5205 Chen Q, Long X, Ji Y, et al. Randomised controlled trial: susceptibility-guided therapy versus empiric bismuth quadruple therapy for first-line Helicobacter pylori treatment. Aliment Pharmacol Ther. 2019;49(11):1385-1394. doi:10.1111/apt.15273 Bonoso Criado R, Pérez Citores L, Pérez Millán AG, et al. Prospective comparative study of the treatment of Helicobacter pylori with antibiotic susceptibility testing-guided triple therapy compared to quadruple therapy with bismuth-metronidazole-tetracycline subcitrate. Rev Esp Enferm Dig . 2021;113(8):597-601. doi:10.17235/reed.2020.7395/2020 Lee JW, Kim N, Nam RH, et al. Favorable outcomes of culture-based Helicobacter pylori eradication therapy in a region with high antimicrobial resistance. Helicobacter . 2019;24(2):e12561. doi:10.1111/hel.12561 Yu L, Luo L, Long X, Liang X, Ji Y, Chen Q, Song Y, Li X, Graham DY, Lu H. Susceptibility-guided therapy for Helicobacter pylori infection treatment failures. Therap Adv Gastroenterol. 2019 Sep 9;12:1756284819874922. doi: 10.1177/1756284819874922. ZHONG Z, ZHANG Z, WANG J, et al. A retrospective study of the antibiotic-resistant phenotypes and genotypes of Helicobacter pylori strains in China [J]. American journal of cancer research, 2021, 11(10): 5027-37. Hu S, Zhou Y, Deng Y, et al. Characteristics of phenotypic antibiotic resistance of Helicobacter pylori and its correlation with genotypic antibiotic resistance: A retrospective study in Ningxia. Helicobacter . 2023;28(3):e12960. doi:10.1111/hel.12960 Pellicano, Rinaldo et al. “A 2016 panorama of Helicobacter pylori infection: key messages for clinicians.” Panminerva medica vol. 58,4 (2016): 304-317. Abadi, Amin Talebi Bezmin, and Johannes G Kusters. “Management of Helicobacter pylori infections.” BMC gastroenterology vol. 16,1 94. 12 Aug. 2016, doi:10.1186/s12876-016-0496-2 Chey, William D et al. “ACG Clinical Guideline: Treatment of Helicobacter pylori Infection.” The American journal of gastroenterology vol. 112,2 (2017): 212-239. doi:10.1038/ajg.2016.563 Alba, Claudio et al. “Antibiotic resistance in Helicobacter pylori.” Current opinion in infectious diseases vol. 30,5 (2017): 489-497. doi:10.1097/QCO.0000000000000396 Graham DY, Lu H. Furazolidone in Helicobacter pylori therapy: misunderstood and often unfairly maligned drug told in a story of French bread. Saudi J Gastroenterol . 2012;18(1):1-2. doi:10.4103/1319-3767.91724 Zhang YW, Hu WL, Cai Y, et al. Outcomes of furazolidone- and amoxicillin-based quadruple therapy for Helicobacter pylori infection and predictors of failed eradication. World J Gastroenterol . 2018;24(40):4596-4605. doi:10.3748/wjg.v24.i40.4596 Zhuge, Liya et al. “Furazolidone treatment for Helicobacter Pylori infection: A systematic review and meta-analysis.” Helicobacte r vol. 23,2 (2018): e12468. doi:10.1111/hel.12468 Niu M, Zhou Y, Xie Y, et al. Comparison of the Dual Therapy of Ilaprazole-Amoxicillin and the Bismuth Quadruple Therapy of Ilaprazole-Amoxicillin-Furazolidone-Bismuth Glycyrrhizinate for Eradication of Helicobacter pylori . Front Pharmacol . 2022;13:771876. Published 2022 Apr 27. doi:10.3389/fphar.2022.771876 Liu, D-S et al. “Primary antibiotic resistance of Helicobacter pylori in Chinese patients: a multiregion prospective 7-year study.” Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases vol. 24,7 (2018): 780.e5-780.e8. doi:10.1016/j.cmi.2017.11.010 Smith, Sinéad M et al. “Helicobacter pylori resistance to current therapies.” Current opinion in gastroenterology vol. 35,1 (2019): 6-13. doi:10.1097/MOG.0000000000000497 Kwon, Yong Hwan et al. “Efficacy of tailored therapy for Helicobacter pylori eradication based on clarithromycin resistance and survey of previous antibiotic exposure: A single-center prospective pilot study.” Helicobacter vol. 24,4 (2019): e12585. doi:10.1111/hel.12585 Additional Declarations No competing interests reported. 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Autonomous Region (Ningxia Medical University Affiliated People's Hospital of Ningxia Autonomous Region)","correspondingAuthor":false,"prefix":"","firstName":"Xianmei","middleName":"","lastName":"Chen","suffix":""},{"id":464907944,"identity":"af9254e2-771d-4952-9493-fb7c064bb507","order_by":2,"name":"Yanling Li","email":"","orcid":"","institution":"People's Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People's Hospital of Ningxia Autonomous Region)","correspondingAuthor":false,"prefix":"","firstName":"Yanling","middleName":"","lastName":"Li","suffix":""},{"id":464907945,"identity":"d143c5dd-576c-4177-8053-04549c7c0a86","order_by":3,"name":"Yuanyuan Tang","email":"","orcid":"","institution":"People's Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People's Hospital of Ningxia Autonomous 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16:23:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6363050/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6363050/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12876-026-04761-1","type":"published","date":"2026-03-28T16:11:08+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":105755997,"identity":"991c4325-8bab-4798-b47b-e237d5524be6","added_by":"auto","created_at":"2026-03-30 16:34:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":763457,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6363050/v1/f738374d-03e7-41e3-86a4-8e90b292ef07.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Eradication efficacy of empiric bismuth quadruple therapy containing amoxicillin in the first-line treatment of Helicobacter pylori in Ningxia, China","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cem\u003eHelicobacter pylori\u003c/em\u003e (\u003cem\u003eH. pylori\u003c/em\u003e) is a gastric Gram-negative, helical, microaerophilic pathogen, which is closely related to the development of chronic gastritis, peptic ulcer, gastric mucosa-associated\u0026nbsp;lymphoid tissue lymphoma, and gastric cancer, in addition to the occurrence of some non-intestinal diseases, such as idiopathic thrombocytopenic epilepsy and iron deficiency anemia. In 1994, the World Health Organization classified \u003cem\u003eH. pylori\u003c/em\u003e as a class I carcinogen, which is the only prokaryotic pathogenic microorganism classified as a carcinogen [1, 2, 3], and the Kyoto global consensus report on \u003cem\u003eH. pylori\u003c/em\u003e gastritis recommended that should be treated in patients with \u003cem\u003eH. pylori\u003c/em\u003e infection, regardless of clinical symptoms. infection should be treated with eradication therapy regardless of the presence or absence of clinical symptoms [3]. Currently, with the widespread development of \u003cem\u003eH. pylori\u003c/em\u003e eradication therapy, as well as the diversification of eradication protocols, the widespread use of antibiotics has led to an increase in resistance to \u003cem\u003eH. pylori\u0026nbsp;\u003c/em\u003eworldwide, especially Metronidazole, Levofloxacin, Clarithromycin, the eradication rate of bismuth quadruple therapy with the increase in antibiotic resistance and the tendency to decrease, and there are even reports that bismuth quadruple therapy containing Clarithromycin or Levofloxacin has been reported to reduce the rate of eradication of \u003cem\u003eH.pylori\u003c/em\u003e infection. The eradication rate of bismuth quadruple therapy is less than 80% [4, 5], but the incidence rate of adverse effects of bismuth quadruple therapy is still high [6, 7], especially those containing Furazolidone or Tetracycline.Increased resistance of \u003cem\u003eH. pylori\u0026nbsp;\u003c/em\u003eto antibiotics is believed to be the main reason for the failure of eradication [8, 9]. Information on antibiotic resistance is important in guiding the treatment of \u003cem\u003eH. pylori\u0026nbsp;\u003c/em\u003eif obtained prior to treatment. Relevant studies have shown that treatment guided by drug resistance detection is comparable to or even better than empirical quadruple therapy [10, 11, 12, 13], and triple therapy can also achieve an eradication rate of more than 90% [14], especially in areas with high antibiotic resistance [15], or in patients who have failed previous eradication therapy [16]. However, resistance-detection-guided therapy has some limitations in clinical practice, mainly due to the low detection rate of \u003cem\u003eH. pylori\u003c/em\u003e, the harsh experimental conditions for bacterial culture, the long incubation period, and the high cost of treatment, especially in areas with high rates of \u003cem\u003eH. pylori\u0026nbsp;\u003c/em\u003einfection and drug resistance, and where healthcare resources are scarce. Due to the obvious geographical differences in the infection and drug resistance rates of \u003cem\u003eH. pylori\u003c/em\u003e, according to the national multicenter data from the China \u003cem\u003eH. pylori\u003c/em\u003e Molecular Medicine Center Surveillance in 2021, the resistance rates of Metronidazole, Clarithromycin, and Levofloxacin were 87.8%, 37.0%, and 34.2%, respectively [17]. Surprisingly, in the face of such a severe regional resistance challenge, several current studies have reported that the resistance rate of \u003cem\u003eH. pylori\u003c/em\u003e to amoxicillin remains low [5, 6, 7, 17], and its low incidence of adverse events during eradication therapy and its reusability have made amoxicillin gradually become the antibiotic of choice for a wide range of therapeutic regimens. \u003cem\u003eH. pylori\u003c/em\u003e infections and drug resistance in the Ningxia region of China in the period 2020-2022, epidemiologic screening for \u003cem\u003eH. pylori\u003c/em\u003e infection and resistance showed resistance rates to Metronidazole, Levofloxacin, Clarithromycin, Amoxicillin, Tetracycline, and Furazolidone of 94.2%, 42.4%, 40.4%, 0.9%, 0.3%, and 0.1%, respectively [18]. Therefore, with a clear background of regional antibiotic resistance, the selection of appropriate antibiotics and a reliable treatment regimen is instructive for the first-line treatment of \u003cem\u003eH. pylori\u003c/em\u003e, and the aim of our study was to evaluate the eradication efficacy of empirical bismuth containing amoxicillin in the first-line treatment of\u003cem\u003e\u0026nbsp;H. pylori\u003c/em\u003e.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and subjects\u0026nbsp;\u003c/strong\u003eThis was a retrospective study in which participants who attended the outpatient clinic of the Department of Gastroenterology of the People's Hospital of Ningxia Hui Autonomous Region with upper gastrointestinal symptoms from June 2021 to October 2022 were selected to undergo the 14-carbon urease breath test (14C-UBT), and participants with a positive result of the 14C-UBT and meeting the exclusion criteria, and the inclusion criteria were included in this study. All participants signed an informed consent form before participating in this trial. The study protocol was approved by the Ethics Committee of Ningxia Hui Autonomous Region People's Hospital (2022LW006) and followed the Declaration of Helsinki. Questionnaires included: gender, age, smoking, alcohol consumption, education level, monthly income (RMB), living area, communal utensils, history of previous antibiotic use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants who were positive for \u003cem\u003eH. pylori\u003c/em\u003e by 14C-UBT, those who were in the age range of 18-75 years, those who were not taking proton pump inhibitors (PPI), bismuth, antibiotics, and non-steroidal drugs in the 4 weeks prior to performing 14C-UBT.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e: participants are less than 18 years old, participants with a clear diagnosis of gastrointestinal tumors or a previous history of a major gastric resection, undergoing radiation or chemotherapy, allergic to or intolerant of medications, pregnant or breastfeeding; participating in other clinical trials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment regimen and observation indexes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dosage and frequency of the base drugs of the bismuth quadruple therapy regimen were Esomeprazole(E) 20mg twice daily, Bismuth(B) agent 220mg twice daily, Amoxicillin(A) 1000mg twice daily, and the duration of treatment was 14 days, including EBAC group: EAB+clarithromycin(C) 500mg twice daily; EBAL group: EAB+levofloxacin(L) 200mg twice daily; EBAF group: EAB+furazolidone(F) 100mg twice daily;EBAT group: EAB+tetracycline(T) 500mg four times daily. Esomeprazole and bismuth were administered orally 30 minutes before a meal. Antibiotics except tetracycline were administered 30 minutes after a meal, and tetracycline was administered 2 hours after a meal. The outcome indicator of this study was eradication rate, participants were retested for 14C-UBT at weeks 4-6 after the end of treatment, and the result was negative suggesting that \u003cem\u003eH. pylori\u003c/em\u003e eradication was successful, eradication rate (%) = [number of cases with negative 14C-UBT retests after eradication treatment/number of cases receiving \u003cem\u003eH. pylori\u003c/em\u003e eradication treatment].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS 23.0 was used to statistically analyze the entered data, and the count data were expressed as percentage (%), and the chi-square test was used, and the difference was considered to be statistically significant when \u003cem\u003eP\u003c/em\u003e-value \u0026lt;0.05, and the treatment results would be analyzed using the Intention-to-treat (ITT) analysis and the Follow the research protocol (Per-Protocol, PP) analysis. The analysis of relevant influencing factors was expressed using Diagnostic odds ratio (OR) values, and differences were considered statistically significant when the upper limit of the 95% confidence interval (CI) was less than 1 or the lower limit was greater than 1.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eEmpirical treatment regimen eradication rate A total of 874 patients who met the exclusion criteria were included in this study, and the overall empirical bismuth quadruple therapy eradication rates for the ITT analysis and PP analysis were 76.3% (665/874; 95%CI 73.5-79.2), 84.6% (665/786; 95%CI 82.1 -87.1). Among 271 cases in the EBAC group, the eradication rates of ITT analysis and PP analysis were 74.2% (201/271; 95%CI 68.9-79.4) and 82.0% (201/245; 95%CI 77.2-86.9), respectively; and among 268 cases in the EBAL group, the eradication rates of ITT analysis and PP analysis were 75.4% ( 202/268; 95%CI 70.2-80.6), 84.9% (202/238; 95%CI 80.3-89.5); in 152 cases in the EBAF group, the eradication rates of ITT analysis and PP analysis were 82.9% (126/152; 95%CI 76.8-88.9) and 91.3% (126/138; 95%CI 86.5-96.1); 183 patients were included in the EBAT group, with eradication rates of 74.3% (136/183; 95%CI 67.9-80.7) and 82.4% (136/165; 95%CI 76.6-88.3) for the ITT and PP analyses, respectively. None of the above differences in the eradication rates of ITT and PP analyses among the different treatment groups were statistically significant(ITT:\u0026nbsp;c=4.809,\u003cem\u003eP\u003c/em\u003e=0.186; PP:\u0026nbsp;c=6.608,\u003cem\u003eP\u003c/em\u003e=0.086), Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1. Comparison of ITT and PP analysis eradication rates in different treatment groups.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"516\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eEBAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eEBAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eEBAF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eEBAT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eITT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e74.2%(201/271)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e75.4%(202/268)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e82.9%(126/152)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e74.3%(136/183)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e68.9-79.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e70.2-80.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e76.8-88.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e67.9-80.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003ePP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e82.0%(201/245)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e84.9%(202/238)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e91.3%(126/138)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e82.4%(136/165)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e77.2-86.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e80.3-89.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e86.5-96.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e76.6-88.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eEffect of demographic and clinical factors on eradication rates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDemographic and clinical factors affecting eradication rates in the EBAC group, EBAL group, EBAF group and EBAT group were compared among the patients analyzed in PP, and it was found that the eradication rate of \u003cem\u003eH.pylori\u003c/em\u003e was lower in the subjects living in rural areas than in city areas in both the EBAC group and EBAL group (EBAC: 77.7% \u003cem\u003evs.\u0026nbsp;\u003c/em\u003e87.7%; EBAL : 83.6% \u003cem\u003evs.\u0026nbsp;\u003c/em\u003e93.2%). (EBAC: 77.7% \u003cem\u003evs.\u0026nbsp;\u003c/em\u003e87.7%; EBAL: 83.6% \u003cem\u003evs.\u0026nbsp;\u003c/em\u003e93.2%), and the difference in eradication rates between the two was statistically significant (OR 95% CI upper limit less than 1); in the EBAC group and EBAL group, subjects with previous amoxicillin use (6 months prior to receiving eradication therapy) had lower \u003cem\u003eH. pylori\u003c/em\u003e eradication rates than subjects living in cities. The eradication rate of \u003cem\u003eH. pylori\u003c/em\u003e was lower than that of subjects with no prior use of amoxicillin (EBAC: 89.0%\u003cem\u003e\u0026nbsp;vs.\u0026nbsp;\u003c/em\u003e78.5%; EBAL: 89.9%\u003cem\u003e\u0026nbsp;vs.\u0026nbsp;\u003c/em\u003e80.6%), and the differences in the eradication rates between the two groups were statistically significant (lower limit of the 95% CI of the OR value was greater than 1). Factors such as gender, education level, monthly income level, smoking, alcohol, sharing of tableware and cups had no effect on the eradication rate of \u003cem\u003eH.pylori.\u0026nbsp;\u003c/em\u003eTable 2.\u003c/p\u003e\n\u003cp\u003eTable 2. Effect of demographic and clinical factors on eradication rates of different treatment regimens.\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"546\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eEBAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eEBAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eEBAF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eEBAT\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e109(82.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e105(89.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e147(92.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e70(84.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e95(84.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e21(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e69(87.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e66(80.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eOR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.813(0.412-1.603)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.897(0.844-0.954)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.775(0.732-4.309)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.305(0.583-2.921)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eJunior\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e72(80.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e41/(95.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e134(93.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e62(83.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eSenior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e132(84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e85(89.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e82(87.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e74(81.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eOR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.770(0.388-1.527)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e2.412(0.505-11.515)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.961(0.811-4.742)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.187(0.527-2.674)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eMonthly income(RMB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026lt;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e143(81.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e115/(92.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e182(93.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e65(83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026gt;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e61(88.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e11(78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e34(87.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e71(81.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eOR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.568(0.248-1.301)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e3.485(0.821-14.792)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.574(0.544-4.554)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.127(0.504-2.521)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eLiving region\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eRural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e108(77.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e92(83.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e66(90.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e58(82.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eCity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e93(87.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e110(93.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e60(92.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e78(82.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eOR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.487(0.241-0.985)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.372(0.155-0.894)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.786(0.237-2.608)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.053(0.467-2.376)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eUsed amoxicillin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e73(89.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e98(89.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e49(90.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e52(88.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e128(78.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e104(80.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e77(91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e84(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eOR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e2.218(1.010-4.872)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e2.142(1.001-4.584)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.891(0.268-2.965)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.061(0.393-2.868)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eSmoking\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e136(83.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e18(90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e108(92.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e54(83.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e68(82.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e101(87.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e18(85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e82(82.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eOR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.037(0.551-2.105)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1.034(0.518-2.062)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e2.000(0.494-8.100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.078(0.472-2.459)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eAlcohol\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e142(84.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e105/(92.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e173(90.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e96(82.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e62(80.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e21(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e43(93.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e40(83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eOR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.321(0.655-2.666)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1.667(0.416-6.679)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.635(0.180-2.425)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.914(0.374-2.235)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eShared tableware\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eSometimes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e73(88.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e80(92.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e42(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e50(84.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eRegular\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e131(80.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e46(90.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e174(91.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e86(81.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eOR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.727(0.801-3.724)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1.242(0.373-4.139)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.644(0.238-1.744)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.292(0.546-3.055)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eShared water cup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eSometimes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e186(83.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e106(90.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e196(90.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e106(83.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eRegular\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e18(85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e20(95.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e20(90.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e30(78.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eOR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.816(0.229-2.908)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.482(0.059-3.943)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.980(0.213-4.502)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.346(0.542-3.343)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003cp\u003eNote:*: \u003cem\u003eP \u0026lt; 0.05\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of adverse events between empiric therapy\u0026nbsp;\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe incidence of adverse events of EBAT, EBAF, EBAC and EBAL group was 29.7%, 24.0%, 13.9%, 8.4%, 7.7%, respectively. Notably, the incidence of adverse reactions was significantly different among the groups (c=52.900, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), and the difference between mild and moderate adverse events in the empiric treatment group was significant (c=16.499,\u003cem\u003eP\u003c/em\u003e=0.002;\u0026nbsp;c= 44.280, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), Table 3.\u003c/p\u003e\n\u003cp\u003eTable 3. Adverse events of each empiric treatment regimen.\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"513\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eEBAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eEBAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eEBAF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eEBAT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e%(n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e34(13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e20(8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e33(24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e49(29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eAE\u0026nbsp;level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e26(10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e18(7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e20(14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e30(18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e8(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e13(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e19(11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eAE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eNausea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e7(2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e8(3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e9(5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eVomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e3(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e5(3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eAbdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e6(2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e5(3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e8(4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eAbdominal distension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e15(6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e14(10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e14(8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eDiarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e3(2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e6(6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eSkin rash\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e3(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eHeadache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e5(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eDizzy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cem\u003eH.pylori\u003c/em\u003e is a Gram-negative, helical, microaerophilic pathogen that has infected more than 50% of the population worldwide due to its ability to resist the acidic gastric environment [19-21]. \u003cem\u003eH.pylori\u003c/em\u003e infection has been associated not only with different digestive disorders such as gastritis, peptic ulcer, mucosa-associated lymphoid tissue lymphoma, and gastric adenocarcinoma, but also with the development of iron deficiency anemia, vitamin B12 deficiency, and idiopathic thrombocytopenic purpura [22]. The population is generally susceptible to \u003cem\u003eH. pylori\u003c/em\u003e, and the 2015 Tokyo Global Consensus Report recommends that for \u003cem\u003eH.pylori\u003c/em\u003e-infected individuals, regardless of the presence or absence of clinical symptoms, they should receive eradication therapy, and the current domestic and international consensus opinions recommend bismuth quadruple therapy as a first-line treatment regimen for \u003cem\u003eH.pylori\u0026nbsp;\u003c/em\u003e[3, 4, 5], but with the widespread eradication of \u003cem\u003eH. pylori\u0026nbsp;\u003c/em\u003ebismuth quadruple regimen eradication rates have been on a downward trend, \u003cem\u003eH.pylori\u0026nbsp;\u003c/em\u003eincreased resistance to antibiotics is considered to be the main reason for eradication failure, and resistance regarding \u003cem\u003eH.pylori\u0026nbsp;\u003c/em\u003ehas become an inevitable challenge in eradication treatment, therefore, selecting appropriate antibiotics and treatment regimens for first-line empirical treatment in areas with high rates of \u003cem\u003eH.pylori\u0026nbsp;\u003c/em\u003einfection and resistance can provide some reference for localized eradication of \u003cem\u003eH.pylori\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eOur findings showed that the eradication rates in the empirical bismuth quadruple therapy treatment groups were 76.3% (665/874; 95% CI 73.5-79.2), 84.6% (665/786; 95% CI 82.1-87.1), respectively, with the highest eradication rates in the EBAF group, with eradication rates analyzed by ITT, PP, of 82.9% (126/152; 95% CI 76.8-88.9), and 91.3% (126/138; 95% CI 86.5-96.1), respectively. The current resistance rate to furazolidone is low (\u0026lt;5%), and studies have shown that furazolidone-containing regimens can achieve better efficacy compared to other empirical bismuth quadruple regimens of the same duration [23]. A retrospective study showed a 95.3% primary eradication rate for bismuth quadruple therapy containing amoxicillin in combination with furazolidone [24]. In addition, a Meta-analysis of the eradication efficacy of furazolidone showed that the furazolidone-containing regimen was more efficacious than other antibiotic regimens of the same duration of treatment in terms of eradication rate (ITT: 81.1% vs. 75.4%, PP: 86.6% vs. 80.1%), with no significant increase in adverse effects (\u0026lt;10%) [25]. However, the results of Niu M's study showed that the PP eradication rate of bismuth quadruple regimen containing furazolidone with a course of 14 days was 94.7%, but had a high incidence of adverse reactions (24.8%) compared to the other treatment regimens [26]. The EBAF group in this study had a higher ITT and PP eradication rate analyzed than the empirical EBAC, EBAL and EBAT groups, but the efficacy was not superior to the other bismuth quadruple therapy groups. As with EBAT group, the incidence of AEs was more than 20%, and the grade of AEs in both groups was mainly \"mild\", and the high incidence of adverse effects might be one of the reasons affecting the eradication effect of the furazolidone and tetracycline regimen. The incidence of adverse effects of furazolidone is related to the dosage and duration of administration [23], and tetracycline may cause significant hepatic and renal impairment, so the use of furazolidone should be done under the guidance of a clinician, and the occurrence of adverse effects should be monitored, and the use of tetracycline should be monitored for the same reason.\u003c/p\u003e\n\u003cp\u003eThe results of the present study showed a poor eradication rate in the clinically used EBAC and EBAL groups (ITT: 74.2%\u003cem\u003evs.\u0026nbsp;\u003c/em\u003e75.4%; PP: 83.0%\u003cem\u003evs.\u0026nbsp;\u003c/em\u003e84.9%), which is generally consistent with the results of other studies [23-25]. In the EBAC and EBAL groups, the eradication rate of \u003cem\u003eH.pylori\u003c/em\u003e in patients living in rural areas was lower than that in urban populations, which may be related to the high prevalence of \u003cem\u003eH.pylori\u003c/em\u003e infection in rural areas, poorer healthcare and hygiene, weaker personal health awareness, and fewer clinical antimicrobial drug choices. Amoxicillin, clarithromycin and levofloxacin are widely used antibiotics in clinical practice, and the three are often applied in the treatment of infectious diseases outside the gastrointestinal tract, especially in the respiratory system and inflammatory diseases in the urinary system, and there are characteristics of inflammation in the urinary system and pneumonia that are easy to recur and require multiple treatments, which may be due to the indirect application of clarithromycin and levofloxacin in infectious diseases outside the gastrointestinal tract in terms of the course of treatment, type and frequency of medication has not yet reached the eradication of \u003cem\u003eH.pylori\u0026nbsp;\u003c/em\u003eand is associated with the increase of \u003cem\u003eH.pylori\u003c/em\u003e resistance due to the accumulation of antimicrobial drugs over time [27], but of course the mechanism of this increase of \u003cem\u003eH.pylori\u0026nbsp;\u003c/em\u003eresistance due to the accumulation of antimicrobial drugs over time still needs to be confirmed by further studies. Related studies analyzing antibiotic consumption in Europe showed a significant association between macrolide use and \u003cem\u003eH.pylori\u003c/em\u003e resistance to clarithromycin, and a significant association between quinolone use and levofloxacin resistance [28]. The results of Kwon's study were consistent with this finding and showed that a history of macrolide and quinolone use was associated with a decrease in the eradication rate of bismuth tetracycline containing clarithromycin, and levofloxacin containing bismuth, respectively [29]. The results of this study showed that previous use of amoxicillin affected the eradication of \u003cem\u003eH.pylori\u003c/em\u003e, and according to the 2020-2022 study of\u003cem\u003e\u0026nbsp;H.pylori\u003c/em\u003e resistance in Ningxia, the resistance rate of metronidazole in this region was 94.2%, that of both clarithromycin and levofloxacin was more than 40%, and that of tetracycline and furazolidone was less than 5%, and that the rate of multi-drug resistance was 24.2%. In the face of such a severe resistance challenge, the use of potentially resistant clarithromycin and levofloxacin for the eradication of \u003cem\u003eH.pylori\u003c/em\u003e in the absence of clarity about resistance at the time of eradication greatly increases the risk of treatment failure, and this risk of treatment failure due to a high rate of single resistance or an increase in the rate of multi-resistance may be more pronounced in patients with prior amoxicillin use. However, our results show that prior amoxicillin use did not significantly affect \u003cem\u003eH.pylori\u003c/em\u003e eradication rates in the EBAF and EBAT groups, and perhaps the use of furazolidone and tetracycline, which have lower resistance rates (\u0026lt;5%), may overcome the adverse effects of prior amoxicillin use to some extent.\u003c/p\u003e\n\u003cp\u003eThe eradication rate of empirical bismuth quadruple therapy containing amoxicillin in this region ranged from 74.2%-82.9% in ITT analysis and 82.0%-91.3% in PP analysis, and overall the eradication rate of bismuth quadruple therapy containing amoxicillin was poor in this region and the eradication rate was affected by the history of previous medication with amoxicillin, especially in the clarithromycin and levofloxacin groups. Obviously, in the face of the dilemma of high \u003cem\u003eH.pylori\u003c/em\u003e resistance to metronidazole, clarithromycin, and levofloxacin, and poor eradication rate of bismuth quadruple therapy in this region, the overall downward trend of first-time eradication success rate has not been effectively controlled despite the increasing variety of combinations of the consensus-recommended \u003cem\u003eH.pylori\u003c/em\u003e eradication regimen and the increasing duration or dosage of the regimens, and it would be helpful to obtain pre-treatment antibiotic The availability of antibiotic resistance information prior to treatment can positively guide the eradication of \u003cem\u003eH.pylori\u003c/em\u003e. Several scholars have shown that individualized treatment based on drug sensitivity analysis is more effective than empirical treatment with the same course of treatment [9-13], especially in areas with high antibiotic resistance rates [15]. Individualized treatment guided by the results of drug sensitivity test before treatment can achieve better eradication results and can promote the rational application of antibiotics, which may be an effective way to improve the eradication rate of \u003cem\u003eH.pylori\u003c/em\u003e in Ningxia, China. Therefore, we will evaluate the efficacy and safety of individualized bismuth quadruple therapy guided by resistance detection in subsequent studies.\u003c/p\u003e\n\u003cp\u003eThis study still has some limitations, this study is a retrospective study, some of the data may have some bias; 2) it is not comprehensive enough in the collection of clinical data, and did not include the previous use of clarithromycin, levofloxacin, furazolidone, and tetracycline, which resulted in the unclear effect of the above medications on the corresponding treatment regimen, in the EBAT group, 10 participants were unable to provide accurate information about the past use of amoxicillin, which may affect the analysis and discussion of the results in this group; 3) this study is a regional single-center study, with a small amount of sample data, and a multicenter study is needed to expand the sample size in the follow-up.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eEBAC, EBAL, EBAT, and EBAF regimens containing amoxicillin have similar efficacy in the Ningxia region of China, and all of them can be used for first-line treatment of \u003cem\u003eH.pylori\u0026nbsp;\u003c/em\u003ein this region, and the incidence of adverse effects of furazolidone and tetracycline should be monitored in the eradication treatment.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cem\u003eH. Pylori \u0026nbsp; \u0026nbsp; \u0026nbsp;Helicobacter pylori\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e14C-UBT \u0026nbsp; \u0026nbsp; \u0026nbsp;14-carbon urease breath test\u003c/p\u003e\n\u003cp\u003eITT \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Intention-to-treat analysis\u003c/p\u003e\n\u003cp\u003ePP \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Per-protocol\u003c/p\u003e\n\u003cp\u003eAE \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Adverse event\u003c/p\u003e\n\u003cp\u003eOR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Odds ratio\u003c/p\u003e\n\u003cp\u003eCI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Confidence interval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePPI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Proton pump inhibitor\u003c/p\u003e\n\u003cp\u003eE \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Esomeprazole\u003c/p\u003e\n\u003cp\u003eB \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Bismuth\u003c/p\u003e\n\u003cp\u003eA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Amoxicillin\u003c/p\u003e\n\u003cp\u003eC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Clarithromycin\u003c/p\u003e\n\u003cp\u003eL \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Levofloxacin\u003c/p\u003e\n\u003cp\u003eF \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Furazolidone\u003c/p\u003e\n\u003cp\u003eT \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Tetracycline\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Ethics Committee of Ningxia Hui Autonomous Region People's Hospital (2022LW006) and followed the Declaration of Helsinki. All participants signed an informed consent form before participating in this trial.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFundings\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany thanks to the governmental departments and various hospitals in Ningxia Hui Autonomous Region for providing support and assistance in conducting this study. This study was supported by the Key Research and Development Program of Ningxia Hui Autonomous Region (No. 2021BEG02025), and the Key scientific and technological achievements transformation projects of Ningxia Hui Autonomous Region (No. 2024CJE09045).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSXM and HSJ designed the experiment. CXM, TYY, WYT and LYL conducted the experiment. SXM analysed the samples and performed data analysis. SXM produced the first draft of the manuscript and HSJ contributed to drafting and editing the manuscript. All the authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e\u003cem\u003eThe Fifth People's Hospital of Ningxia Hui Autonomous Region\u003c/em\u003e\u003cem\u003e,\u0026nbsp;\u003c/em\u003e\u003cem\u003eShizuishan 753000, China. \u003csup\u003e2\u003c/sup\u003ePeople's Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People's Hospital of Ningxia Autonomous Region), Yinchuan 750000, China.\u003c/em\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSugano K, Tack J, Kuipers EJ, et al. 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Published 2022 Apr 27. doi:10.3389/fphar.2022.771876\u003c/li\u003e\n\u003cli\u003eLiu, D-S et al. \u0026ldquo;Primary antibiotic resistance of Helicobacter pylori in Chinese patients: a multiregion prospective 7-year study.\u0026rdquo; \u003cem\u003eClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases\u003c/em\u003e\u003cem\u003e \u003c/em\u003evol. 24,7 (2018): 780.e5-780.e8. doi:10.1016/j.cmi.2017.11.010\u003c/li\u003e\n\u003cli\u003eSmith, Sin\u0026eacute;ad M et al. \u0026ldquo;Helicobacter pylori resistance to current therapies.\u0026rdquo; \u003cem\u003eCurrent opinion in gastroenterology\u003c/em\u003e\u003cem\u003e \u003c/em\u003evol. 35,1 (2019): 6-13. doi:10.1097/MOG.0000000000000497\u003c/li\u003e\n\u003cli\u003eKwon, Yong Hwan et al. \u0026ldquo;Efficacy of tailored therapy for Helicobacter pylori eradication based on clarithromycin resistance and survey of previous antibiotic exposure: A single-center prospective pilot study.\u0026rdquo; \u003cem\u003eHelicobacter\u003c/em\u003e\u003cem\u003e \u003c/em\u003evol. 24,4 (2019): e12585. doi:10.1111/hel.12585\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Helicobacter pylori, quadruple therapy, eradication rate","lastPublishedDoi":"10.21203/rs.3.rs-6363050/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6363050/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eOBJECTIVE:\u003c/strong\u003eThe objective was to evaluate the eradication rate and safety of bismuth quadruple therapy containing amoxicillin in the first-line empiric treatment in with high resistance to \u003cem\u003eHelicobacter pylori\u003c/em\u003e (\u003cem\u003eH. pylori\u003c/em\u003e) in China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS:\u003c/strong\u003eThis was a retrospective study of 874 \u003cem\u003eH.pylori\u003c/em\u003e-infected patients who attended the outpatient clinic of the Department of Gastroenterology of the People's Hospital of Ningxia Hui Autonomous Region from June 2021 to October 2022 and met the criteria for exclusion, including Esomeprazole-Bismuth-Amoxicillin-Clarithromycin (EBAC) group, Esomeprazole-Bismuth-Amoxicillin-Levofloxacin (EBAL) group, Esomeprazole-Bismuth-Amoxicillin-Furazolidone (EBAF) group, Esomeprazole-Bismuth-Amoxicillin-Tetracycline (EBAT) group, and the duration of treatment was 14 days. Eradication of \u003cem\u003eH. pylori\u003c/em\u003e was determined by a repeat 14-carbon urease breath test (14C-UBT) at weeks 4-6 after the end of treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS:\u003c/strong\u003eIn the intention-to-treat analysis (ITT), the eradication rates of \u003cem\u003eH. pylori\u003c/em\u003ein the EBAC, EBAL, EBAF, and EBAT groups were 74.2% (201/271), 75.4% (202/268), 82.9% (126/152), and 74.3% (136/183), respectively; and in the per-protocol (PP) analysis, the PP analysis eradication rates were 83.0% (201/245), 84.9%(202/238), 91.3%(126/138), and 82.4% (136/165), and the differences in the eradication rates of the four groups for ITT and PP analysis were not statistically significant (ITT: \u003cem\u003eP \u003c/em\u003e= 0.186; PP: \u003cem\u003eP \u003c/em\u003e= 0.086). The incidence rates of adverse event(AE) in the EBAC, EBAL, EBAF and EBAT groups was 13.9% (34/245), 8.4% (20/238), 24.0% (33/138) and 29.7% (49/165), respectively, with a statistically significant difference (\u003cem\u003eP \u003c/em\u003e\u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eThe efficacy of the amoxicillin-containing regimens in the EBAC, EBAL, EBAT and EBAF groups in Ningxia, China, was similar, and all of them can be used for first-line treatment of \u003cem\u003eH.pylori\u003c/em\u003e in this region, and the incidence of adverse effects of furazolidone and tetracycline should be monitored.\u003c/p\u003e","manuscriptTitle":"Eradication efficacy of empiric bismuth quadruple therapy containing amoxicillin in the first-line treatment of Helicobacter pylori in Ningxia, China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-02 16:24:39","doi":"10.21203/rs.3.rs-6363050/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-01T04:10:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-12T04:37:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-10T13:48:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"186935398265665934274010931661755220989","date":"2025-06-04T15:39:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"104425497968622355201373941962957874284","date":"2025-06-01T23:26:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-31T10:40:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"77550663341359489620250165589904688952","date":"2025-05-30T15:03:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-30T14:56:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-08T09:28:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-23T14:28:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-22T14:45:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2025-04-22T14:43:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"db38887e-c7ca-4e22-8375-ace241e6bde6","owner":[],"postedDate":"June 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:28:26+00:00","versionOfRecord":{"articleIdentity":"rs-6363050","link":"https://doi.org/10.1186/s12876-026-04761-1","journal":{"identity":"bmc-gastroenterology","isVorOnly":false,"title":"BMC Gastroenterology"},"publishedOn":"2026-03-28 16:11:08","publishedOnDateReadable":"March 28th, 2026"},"versionCreatedAt":"2025-06-02 16:24:39","video":"","vorDoi":"10.1186/s12876-026-04761-1","vorDoiUrl":"https://doi.org/10.1186/s12876-026-04761-1","workflowStages":[]},"version":"v1","identity":"rs-6363050","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6363050","identity":"rs-6363050","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}