A new quadruple therapy for Helicobacter pylori:: influence of resistant strains on treatment outcome
A new quadruple therapy for Helicobacter pylori:: influence of resistant strains on treatment outcome
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DOI：
10.1046/j.1365-2036.1999.00551.x
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发表时间：
1999-06-01
影响因子：
7.6
通讯作者：
Takata, T
中科院分区：
文献类型：
--
作者：
Okada, M;Nishimura, H;Takata, T
背景资料：目前还没有关于奥美拉唑，阿莫西林，罗红霉素和甲硝唑的1周四联治疗方案的有效性和安全性的幽门螺杆菌infections和原发性耐药的根除率的影响的报告。幽门螺杆菌感染者进入奥美拉唑20 mg o.m.的开放性研究，阿莫西林500 mg t.d.s.，罗红霉素150 mg b.d.，和甲硝唑250 mg t.d.s.幽门螺杆菌状态通过尿素酶试验、组织学和培养来确定。用E-test法测定对阿莫西林、甲硝唑、罗红霉素的敏感性。通过意向治疗分析，169例患者中有155例（92%; 95% CI 88-96%）根除了幽门螺杆菌，通过符合方案分析，163例患者中有155例（95%; 95% CI 92-98%）根除了幽门螺杆菌。对阿莫西林、罗红霉素和甲硝唑的原发耐药率分别为2/166（1%）、16/166（10%）和27/166（16%）。H. 27例甲硝唑耐药菌株患者中有25例（93%）根除了幽门螺杆菌，而136例甲硝唑敏感菌株患者中有130例（96%）根除了幽门螺杆菌。幽门。罗红霉素耐药的16例患者中有15例（94%）根除，而罗红霉素敏感的147例患者中有140例（95%）根除。pylori，2/2例（100%）阿莫西林耐药菌株患者，161例阿莫西林敏感菌株患者中有153例（95%）。H.对甲硝唑和罗红霉素双重耐药的4例患者中有3例（75%）根除了幽门螺杆菌，而对甲硝唑和/或罗红霉素敏感菌株的159例患者中有152例（96%）根除了幽门螺杆菌。这些差异均无统计学显著性。结论：奥美拉唑、阿莫西林、甲硝唑、罗红霉素四联疗法1周可根除H. pylori感染率超过90%还发现该方案对治疗前对甲硝唑、罗红霉素或阿莫西林耐药菌株的患者有益，并且观察到安全性和耐受性良好。
Background: There have been no reports concerning the efficacy and safety of a 1-week quadruple therapy regimen of omeprazole, amoxycillin, roxithromycin and metronidazole for Helicobacter pylori infections and the impact of primary resistance on the eradication rate.Methods: One hundred and sixty-nine consecutive patients with peptic ulcer disease as well as gastritis with biopsy-proven H. pylori infection were entered into an open study of omeprazole 20 mg o.m., amoxycillin 500 mg t.d.s., roxithromycin 150 mg b.d., and metronidazole 250 mg t.d.s. Helicobacter pylori status was determined by urease test, histology and culture. Susceptibility to amoxycillin, metronidazole and roxithromycin was determined by the E-test.Results: H. pylori was eradicated in 155 out of 169 (92%; 95% CI 88-96%) by intention-to-treat analysis, and in 155 out of 163 (95%; 95% CI 92-98%) by per protocol analysis. The prevalence of primary resistance against amoxycillin, roxithromycin and metronidazole was 2 out of 166 (1%), 16 out of 166 (10%) and 27 out of 166 (16%), respectively. H. pylori was eradicated in 25 out of 27 (93%) patients with metronidazole-resistant strains compared with 130 out of 136 (96%) in patients with metronidazole-sensitive strains of H. pylori. It was eradicated in 15 out of 16 (94%) patients with roxithromycin-resistant strains while in 140 out of 147 (95%) patients with roxithromycin-sensitive strains of H. pylori, and in two out of two (100%) patients with amoxycillin-resistant stains compared with 153 out of 161 (95%) in patients with amoxycillin-sensitive strains. H. pylori was eradicated in three out of four (75%) patients with double resistance against metronidazole and roxithromycin compared with 152 out of 159 (96%) patients with sensitive strains to metronidazole and or roxithromycin. None of these differences were statistically significant. Severe side-effects were found in only one out of 169 patients-anaphylaxis due to penicillin.Conclusions: The 1-week quadruple therapy with omeprazole, amoxycillin, metronidazole and roxithromycin was found to eradicate H. pylori in over 90% of all patients. This regimen was also found to be beneficial for patients with pre-treatment resistant strains to metronidazole, roxithromycin or amoxycillin, and was observed to be safe and well-tolerated.