Efficacy of Bismuth-Containing Quadruple Therapies for Clarithromycin-, Metronidazole-, and Fluoroquinolone-Resistant Helicobacter pylori Infections in a Prospective Study
Efficacy of Bismuth-Containing Quadruple Therapies for Clarithromycin-, Metronidazole-, and Fluoroquinolone-Resistant Helicobacter pylori Infections in a Prospective Study
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前瞻性研究中含铋四联疗法对克拉霉素、甲硝唑和氟喹诺酮耐药幽门螺杆菌感染的疗效
DOI：
10.1016/j.cgh.2013.01.008
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发表时间：
2013-07-01
影响因子：
12.6
通讯作者：
Lu, Hong
中科院分区：
文献类型：
--
作者：
Liang, Xiao;Xu, Xiaoqing;Lu, Hong
背景与目的：我们评估的有效性和安全性4铋含四联方案作为经验性治疗幽门螺杆菌感染的患者谁没有响应以前treatment.METHODS：我们进行了前瞻性单中心研究424例幽门螺杆菌感染，没有根除以前的治疗。患者被随机分配至兰索拉唑组（30 mg，每日两次）和枸橼酸铋钾（220 mg，每日两次），沿着500 mg四环素和400 mg甲硝唑，每日4次（LBTM），500 mg四环素和100 mg呋喃唑酮，每日3次（LBTF），1000 mg阿莫西林，每日3次和500 mg四环素，每日4次（LBAT），或1000 mg阿莫西林和100 mg呋喃唑酮，每日3次（LBAF）。通过C-13-尿素呼气试验评估根除情况。通过琼脂稀释法评估了188例患者的抗菌药物敏感性。结果：所有方案的幽门螺杆菌根除率均大于90%：对于LBTM，93.1%（95%置信区间[CI]，88.1%-98.0%），LBTF为96.1%（95% CI，92.4%-99.8%），LBAT为94.6%（95% CI，90.0%-99.2%），LBAF为99.0%（95% CI，97.0%-100%）。LBTM的意向治疗应答率为87.9%（95% CI，81.7%-94.0%），LBTF为91.7%（95% CI，87.1%-96.3%），LBAT为83.8%（95% CI，76.8%-90.9%），LBAF为95.2%（95% CI，91.1%-99.3%）。含呋喃唑酮方案根除感染的患者显著多于非呋喃唑酮方案（P = 0.01）。33.6%的受试者发生了副作用，LBTM组的发生率明显高于其他3组（与LBTF相比，P = .006;与LBAT相比，P = .003;与LBAF相比，P = .02）。甲硝唑耐药率为96.8%，没有菌株耐阿莫西林，四环素，或furazolidone.CONCLUSIONS：四铋含四联疗法实现了大于90%的根除幽门螺杆菌的患者谁不响应以前的治疗，包括甲硝唑耐药的患者。对青霉素过敏的患者，推荐使用四环素和含甲硝唑或呋喃唑酮的治疗方案。
BACKGROUND & AIMS: We assessed the efficacy and safety of 4 bismuth-containing quadruple regimens as empiric therapies for Helicobacter pylori infections in patients who did not respond to previous treatment.METHODS: We performed a prospective single-center study of 424 patients with H pylori infection that was not eradicated by previous therapies. Patients were assigned randomly to groups given lansoprazole (30 mg twice daily) and bismuth potassium citrate (220 mg twice daily), along with 500 mg tetracycline and 400 mg metronidazole 4 times daily (LBTM), 500 mg tetracycline and 100 mg furazolidone 3 times daily (LBTF), 1000 mg amoxicillin 3 times and 500 mg tetracycline 4 times daily (LBAT), or 1000 mg amoxicillin and 100 mg furazolidone 3 times daily (LBAF). Eradication was assessed by a C-13-urea breath test. Antimicrobial susceptibility was assessed in 188 patients by the agar dilution method.RESULTS: Per-protocol rates of H pylori eradication were greater than 90% for all regimens: 93.1% for LBTM (95% confidence interval [CI], 88.1%-98.0%), 96.1% for LBTF (95% CI, 92.4%-99.8%), 94.6% for LBAT (95% CI, 90.0%-99.2%), and 99.0% for LBAF (95% CI, 97.0%-100%). The intention-to-treat response rates were 87.9% for LBTM (95% CI, 81.7%-94.0%), 91.7% for LBTF (95% CI, 87.1%-96.3%), 83.8% for LBAT (95% CI, 76.8%-90.9%), and 95.2% for LBAF (95% CI, 91.1%-99.3%). Significantly more patients had infections eradicated by furazolidone-containing regimens than nonfurazolidone regimens (P = .01). Side effects occurred in 33.6% of subjects and occurred significantly more frequently in the LBTM group than the other 3 groups (vs LBTF, P = .006; vs LBAT, P = .003; vs LBAF, P = .02). Metronidazole resistance was 96.8%; no isolates were resistant to amoxicillin, tetracycline, or furazolidone.CONCLUSIONS: Four bismuth-containing quadruple therapies achieved greater than 90% eradication of H pylori in patients who did not respond to previous treatment, including patients with metronidazole resistance. For patients allergic to penicillin, tetracycline and either metronidazole-or furazolidone-containing regimens are recommended.