Quadruple rescue therapy for Helicobacter pylori infection after two treatment failures
Quadruple rescue therapy for Helicobacter pylori infection after two treatment failures
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DOI：
10.1111/j.1365-2362.2008.01951.x
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发表时间：
2008-06-01
影响因子：
5.5
通讯作者：
Lai, K. H.
中科院分区：
文献类型：
--
作者：
Hsu, P. I.;Wu, D. C.;Lai, K. H.
背景幽门螺杆菌感染缺乏标准的三线治疗，并且在临床实践中经常无法获得根除治疗失败患者的抗菌药物敏感性数据。因此，我们设计了这项前瞻性研究，以评估左氧氟沙星、阿莫西林、铋和雷巴拉唑四联疗法作为幽门螺杆菌感染三线治疗的疗效。患者和方法：2005年9月至2007年8月，37例标准一线和二线治疗失败的幽门螺杆菌感染患者接受了为期10天的四联治疗，包括雷别拉唑（每天20毫克）、亚柠檬酸铋（每天300毫克）、阿莫西林（每天500毫克）和左氧氟沙星（每天500毫克）。治疗结束后6周随访内镜、快速脲酶试验、组织学检查及培养，评价治疗效果。结果37例患者中有31例成功根除幽门螺杆菌（意向治疗分析和方案分析均为84%）。所有患者都遵守了根除治疗，只有7名患者（19%）抱怨有轻中度不良事件。阿莫西林和左氧氟沙星耐药菌株分别在17%和22%的患者中观察到。幽门螺杆菌根除率与抗生素耐药性之间无显著差异。结论以左氧氟沙星和阿莫西林为基础的10 d四联治疗是治疗幽门螺旋杆菌感染的三线经验疗法，耐受性好，根除率高。
Background A standard third-line therapy for Helicobacter pylori infection is lacking, and antimicrobial sensitivity data for patients who failed eradication therapy are often unavailable in clinical practice. We therefore designed the prospective study to assess the efficacy of levofloxacin, amoxicillin, bismuth and rabeprazole quadruple therapy as a third-line treatment for H. pylori infection.Patients and methods From September 2005 to August 2007, 37 consecutive H. pylori-infected patients who had failed standard first-line and second-line treatments underwent a 10-day quadruple therapy comprising rabeprazole (20 mg b.i.d.), bismuth subcitrate (300 mg q.d.s.), amoxicillin (500 mg q.d.s.) and levofloxacin (500 mg o.d.). Follow-up endoscopy with rapid urease test, histological examination and culture was performed at 6 weeks after the end of treatment to evaluate the response to therapy.Results Helicobacter pylori was successfully eradicated in 31 out of 37 patients (84% by both intention-to-treat analysis and per-protocol analysis). All patients complied with the eradication therapies, and only seven patients (19%) complained of mild-to-moderate adverse events. Amoxicillin- and levofloxacin-resistant strains were observed in 17% and 22% of the patients, respectively. There were no significant differences between H. pylori eradication rates and antibiotic resistances.Conclusions The 10-day levofloxacin- and amoxicillin-based quadruple therapy is well tolerated and achieves a high eradication rate as a third-line empirical treatment for H. pylori infection.