Sequential and concomitant therapy with four drugs is equally effective for eradication of H pylori infection.
Sequential and concomitant therapy with four drugs is equally effective for eradication of H pylori infection.
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DOI：
10.1016/j.cgh.2009.09.030
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发表时间：
2010-01
期刊：
影响因子：
--
通讯作者：
Graham DY
中科院分区：
文献类型：
--
作者：
Wu DC;Hsu PI;Wu JY;Opekun AR;Kuo CH;Wu IC;Wang SS;Chen A;Hung WC;Graham DY
据报道，质子泵抑制剂（PPI）和阿莫西林序贯治疗，随后PPI、克拉霉素和咪唑类药物治疗，其幽门螺杆菌感染的治愈率优于PPI、阿莫西林、克拉霉素三联治疗。这4种药物的伴随给药（伴随治疗）也是一种有效的治疗策略。我们比较了序贯治疗和合并治疗的疗效，并分析了耐药性对H。幽门感染在232 H. pylori感染的患者，分别给予10天的序贯治疗（n=115）或伴随治疗（n=117）。H.幽门螺杆菌状态通过内窥镜检查或尿素呼气试验确认。意向治疗分析表明，序贯治疗（92.3%; 95%置信区间[CI] 87.5%-97.1%）和伴随治疗（93.0%; 95%CI：88.3%-97.7%）的根除率相似（p=0.83）。序贯治疗（93.1%; 95% CI：90.7%-95.5%）和合并治疗（93.0%; 95% CI：88.3%-97.7%）的符合方案根除结果相似（p= 0.99）。单因素分析显示，克拉霉素依从性和耐药是根除的独立决定因素。双重耐药不影响联合治疗组的根除率，但显著影响序贯治疗组的根除率。克拉霉素耐药率低于预期。PPI、阿莫西林、克拉霉素和咪唑类药物序贯或合并治疗根除H。幽门感染克拉霉素耐药、依从性和不良事件降低了根除水平。伴随治疗更适合于对抗生素具有双重耐药性的地区。
Sequential therapy with a proton pump inhibitor (PPI) and amoxicillin followed by a PPI, clarithromycin, and an imidazole agent reportedly have a better rate of curing Helicobacter pylori infection than PPI, amoxicillin, clarithromycin triple therapy. The concomitant administration of these 4 drugs (concomitant therapy) is also an effective treatment strategy. We compared the efficacies of sequential and concomitant therapy and analyzed the effects of antibiotic resistance in patients with H. pylori infection. In a randomized trial of 232 H. pylori -infected patients from 3 hospitals in Kaohsiung, Taiwan, patients were given 10 days of sequential (n=115) or concomitant (n=117) therapy. H. pylori status was confirmed by endoscopy or urea breath test. Intention-to-treat analysis demonstrated similar eradication rates for sequential (92.3%; 95% confidence interval [CI] 87.5%–97.1%) and concomitant therapy (93.0%; 95% CI: 88.3%–97.7%)(p=0.83). Per-protocol eradication results were similar between for sequential (93.1%; 95% CI: 90.7%–95.5%) and concomitant therapy (93.0%; 95% CI: 88.3%–97.7%) (p= 0.99). Univariate analysis showed that compliance and resistance to clarithromycin were independent determinants of eradication. Dual resistance did not influence the level of eradication in concomitant group, but significantly affected that of the sequential therapy. Clarithromycin resistance was less frequent than expected. Sequential or concomitant therapy with a PPI, amoxicillin, clarithromycin, and an imidazole agent are equally effective and safe for eradication of H. pylori infection. Resistance to clarithromycin, compliance, and adverse events reduced the level of eradication. Concomitant therapy is more suitable for areas with dual resistance to antibiotics.
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