Efficacy of tailored second-line therapy of Helicobacter pylori eradication in patients with clarithromycin-based treatment failure: a multicenter prospective study
Efficacy of tailored second-line therapy of Helicobacter pylori eradication in patients with clarithromycin-based treatment failure: a multicenter prospective study
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克拉霉素治疗失败患者的幽门螺杆菌根除定制二线治疗的疗效：一项多中心前瞻性研究
DOI：
10.1186/s13099-020-00378-1
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发表时间：
2020-08-29
期刊：
影响因子：
4.2
通讯作者：
Ye, Feng
中科院分区：
文献类型：
--
作者：
Kong, Siya;Huang, Keting;Ye, Feng
背景资料：在克拉霉素和铋剂四联疗法（CBQT）失败后，推荐使用左氧氟沙星和铋剂四联疗法（LBQT）根除幽门螺杆菌。我们比较了二线定制铋为基础的四联疗法（TBQT）和经验LBQT.Methods的疗效：CBQT失败的患者被随机分配到接受TBQT或LBQT 14天。所有患者均接受内镜检查，进行基于培养的抗生素敏感性试验。TBQT组中表现出左氧氟沙星敏感的患者随机接受阿莫西林、左氧氟沙星、埃索美拉唑和胶体果胶铋（ALEB）或阿莫西林、呋喃唑酮、埃索美拉唑和胶体果胶铋（AFEB）治疗14天;左氧氟沙星耐药的患者接受AFEB。根据意向治疗（ITT）分析（89.6% vs. 64.8%，P < 0.001）和符合方案（PP）分析（91.1% vs. 67.8%，P <0.001），TBQT组（n = 182）的根除率显著高于LBQT组（n = 182）。根据ITT（86.3% vs. 90.0%，P = 0.56）和PP（88.0% vs. 90.0%，P = 0.75）分析，在TBQT组左氧氟沙星敏感患者中，ALEB（n = 51）和AFEB（n = 50）亚组的根除率相似。克拉霉素和左氧氟沙星的耐药率分别为57.7%和44.5%。结论：TBQT作为CBQT治疗失败后的二线治疗方案比LBQT更有效。在缺乏抗生素敏感性试验的情况下，AFEB治疗可能被用作根除H的补救治疗。避免左氧氟沙星耐药。
Background: After the failure of clarithromycin- and bismuth-based quadruple therapy (CBQT), levofloxacin- and bismuth-based quadruple therapy (LBQT) is recommended forHelicobacter pylorieradication. We compared the efficacies of second-line tailored bismuth-based quadruple therapy (TBQT) and empirical LBQT.Methods: Patients with CBQT failure were randomly assigned to receive TBQT or LBQT for 14 days. All patients underwent endoscopy for culture-based antibiotic susceptibility testing. Patients in the TBQT group exhibiting levofloxacin susceptibility were randomized to receive amoxicillin, levofloxacin, esomeprazole, and colloidal bismuth pectin (ALEB) or amoxicillin, furazolidone, esomeprazole, and colloidal bismuth pectin (AFEB) for 14 days; patients with levofloxacin resistance received AFEB.Results: From May 2016 to June 2019, 364 subjects were enrolled. Eradication rates were significantly higher in the TBQT group (n = 182) than in the LBQT group (n = 182) according to both intention-to-treat (ITT) analysis (89.6% vs. 64.8%, P < 0.001) and per protocol (PP) analysis (91.1% vs. 67.8%, P < 0.001). Among patients in the TBQT group with levofloxacin susceptibility, eradication rates were similar in the ALEB (n = 51) and AFEB (n = 50) subgroups according to both the ITT (86.3% vs. 90.0%, P = 0.56) and PP (88.0% vs. 90.0%, P = 0.75) analyses. Isolated clarithromycin and levofloxacin resistance rates were 57.7% and 44.5%, respectively. The total clarithromycin and levofloxacin resistance rate in strains with dual or triple resistance was 35.7%.Conclusions: TBQT was more effective than LBQT as a second-line strategy after CBQT failure. In the absence of antibiotic susceptibility testing, AFEB therapy might be used as a rescue therapy to eradicateH. pyloriand avoid levofloxacin resistance.