High Efficacy of 14-Day Triple Therapy-Based, Bismuth-Containing Quadruple Therapy for Initial Helicobacter pylori Eradication
High Efficacy of 14-Day Triple Therapy-Based, Bismuth-Containing Quadruple Therapy for Initial Helicobacter pylori Eradication
复制标题
14 天三联疗法、含铋四联疗法对于初步根除幽门螺杆菌的高效
DOI：
10.1111/j.1523-5378.2010.00758.x
复制
发表时间：
2010-06-01
期刊：
影响因子：
4.4
通讯作者：
Lu, Hong
中科院分区：
文献类型：
--
作者：
Sun, Qinjuan;Liang, Xiao;Lu, Hong
背景：目前推荐的PPI+阿莫西林和克拉霉素7天三联疗法的成功率已降至不可接受的范围。目的：观察以三联疗法为基础的含铋四联疗法治疗幽门螺杆菌感染的疗效。方法：将160例Hp阳性的功能性消化不良患者随机分为两组。方案：奥美拉唑20 mg、阿莫西林1.0 g、克拉霉素500 mg和枸橼酸铋钾220 mg，每日两次。80例患者接受7天四联疗法，80例患者接受14天相同疗法。治疗6周后，H.采用13 C-尿素呼气试验评估幽门螺杆菌根除情况。采用琼脂二倍稀释法测定甲硝唑、克拉霉素和阿莫西林对临床分离菌株的最低抑菌浓度。在意向治疗分析（93.7 vs 80.0%; p = .01）和符合方案分析（97.4 vs 82.0%; p = .0016）中，与7天治疗相比，幽门螺杆菌根除成功率。螺杆pylori对甲硝唑、克拉霉素和阿莫西林的耐药率分别为42.1%、18.0%和0%。14天的治疗在克拉霉素耐药菌株患者中明显更有效。结论：加用铋剂和延长疗程可克服H。幽门螺杆菌对克拉霉素的耐药性，并降低细菌负荷。以14天三联疗法为基础的含铋剂四联疗法的ITT成功率为93%，可推荐作为一线根除方案。
Background:The success rate of currently recommended 7-day triple therapy with a PPI plus amoxicillin and clarithromycin has fallen into the unacceptable range. It is urgent to look for a new strategy to treat the infection of Helicobacter pylori.Aims:To observe the efficacy of triple therapy-based, bismuth-containing quadruple therapy for H. pylori treatment.Methods:A total of 160 patients with functional dyspepsia who were Hp+ were randomly assigned into two groups. Regimen: Omeprazole 20 mg, Amoxicillin 1.0 g, Clarithromycin 500 mg and Bismuth Potassium Citrate 220 mg, twice a day. Eighty patients received 7-day quadruple therapy and 80 patients received the same therapy for 14 days. Six weeks after treatment, H. pylori eradication was assessed by 13C-urea breath test. Minimal inhibitory concentrations of metronidazole, clarithromycin and amoxicillin of clinical isolates were determined by the twofold agar dilution method.Results:Fourteen-day therapy led to a significant increase of H. pylori eradication success when compared to 7-day therapy in the intention-to-treat analysis (93.7 vs 80.0%; p = .01), and the per-protocol analysis (97.4 vs 82.0%; p = .0016). The H. pylori resistance rates to metronidazole, clarithromycin and amoxicillin were 42.1, 18.0 and 0%. Fourteen-day therapy was significantly more effective in patients with clarithromycin-resistant strains. Incidences of adverse events were comparable.Conclusions:Addition bismuth and prolonging treatment duration can overcome H. pylori resistance to clarithromycin and decrease the bacterial load. Fourteen-day triple therapy-based, bismuth-containing quadruple therapy achieved ITT success rate 93% and could be recommended as the first line eradication regimen.