A community-based study of Helicobacter pylori therapy using the strategy of test, treat, retest, and re-treat initial treatment failures
A community-based study of Helicobacter pylori therapy using the strategy of test, treat, retest, and re-treat initial treatment failures
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DOI：
10.1111/j.1523-5378.2006.00432.x
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发表时间：
2006-10-01
期刊：
影响因子：
4.4
通讯作者：
Lin, Jaw-Town
中科院分区：
文献类型：
--
作者：
Lee, Yi-Chia;Wu, Hui-Min;Lin, Jaw-Town
背景资料：虽然根除幽门螺杆菌感染可以降低胃癌的风险，但治疗一般人群的最佳方案仍不清楚。我们报告的根除率（意向治疗和每协议）的社区为基础的H。pylori治疗使用的策略测试，治疗，重新测试，并重新处理初始治疗failure.Materials和方法：在2004年，共2658居民招募的C-13-尿素呼气试验。感染阳性结果的受试者接受标准的7天三联治疗（埃索美拉唑40 mg，每日一次，阿莫西林1 g，每日两次，克拉霉素500 mg，每日两次），如果随访试验仍为阳性，则接受10天的再治疗（埃索美拉唑40 mg，每日一次，阿莫西林1 g，每日两次，左氧氟沙星500 mg，每日一次）。两个都是H.结果：在886名有效报告者中，通过意向治疗分析和符合方案分析，初始治疗的根除率分别为86.9%（95%CI：84.7-89.1%）和88.7%（95%CI：86.5-90.9%）。在105例无应答者中，91.4%（95%CI：86-96.8%）的患者再次治疗根除了感染。在接受初始治疗的886例受试者中，798例（90.1%）和所有105例重新治疗的受试者达到了充分的依从性。24%的受试者发生轻度副作用。总体意向治疗和符合方案根除率为97.7%（95%CI：96.7-98.7%）和98.8%（95%CI：98.5-99.3%），仅受依从性差的影响（比值比，3.3; 95%CI，1.99-5.48; p <0.0001）。使用耐药率低的药物，结合检测、治疗、复测策略，需要的再治疗可导致H. pylori从人群中分离出来。这为规划国家或区域范围的根除方案提供了一个模式。
Background: Although eradication of Helicobacter pylori infection can decrease the risk of gastric cancer, the optimal regimen for treating the general population remains unclear. We report the eradication rate (intention-to-treat and per protocol) of a community-based H. pylori therapy using the strategy of test, treat, retest, and re-treat initial treatment failures.Materials and methods: In 2004, a total of 2658 residents were recruited for C-13-urea breath testing. Participants with positive results for infection received a standard 7-day triple therapy (esomeprazole 40 mg once daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily), and a 10-day re-treatment (esomeprazole 40 mg once daily, amoxicillin 1 g twice daily, and levofloxacin 500 mg once daily) if the follow-up tests remained positive. Both H. pylori status and side-effects were assessed 6 weeks after treatment.Results: Among 886 valid reporters, eradication rates with initial therapy were 86.9% (95% confidence interval [CI]: 84.7-89.1%) and 88.7% (95%CI: 86.5-90.9%) by intention-to-treat and per protocol analysis, respectively. Re-treatment eradicated infection in 91.4% (95%CI: 86-96.8%) of 105 nonresponders. Adequate compliance was achieved in 798 (90.1%) of 886 subjects receiving the initial treatment and in all 105 re-treated subjects. Mild side-effects occurred in 24% of subjects. Overall intention-to-treat and per protocol eradication rates were 97.7% (95%CI: 96.7-98.7%) and 98.8% (95%CI: 98.5-99.3%), respectively, which were only affected by poor compliance (odds ratio, 3.3; 95%CI, 1.99-5.48; p < .0001).Conclusions: A comprehensive plan using drugs in which the resistance rate is low in a population combined with the strategy of test, treat, retest, and re-treat of needed can result in virtual eradication of H. pylori from a population. This provides a model for planning country- or region-wide eradication programs.