Chiba N, Marshall C P
Surrey GI Clinic, Guelph, Canada.
Can J Gastroenterol. 2000 Jan;14(1):27-31. doi: 10.1155/2000/916417.
Triple therapy for one week with omeprazole, clarithromycin and metronidazole (OCM) is accepted worldwide as a first line therapy for Helicobacter pylori eradication. It is unclear whether omeprazole needs to be given once or twice daily.
To assess the efficacy and safety of these regimens in a single-centre, Canadian practice.
Histologically proven H pylori-positive patients were treated for seven days with clarithromycin 250 mg bid and metronidazole 500 mg bid, and randomly allocated to omeprazole 20 mg either once or twice daily in this open, cohort study. Endoscopy with histology (two antrum and two body biopsies, Giemsa stain) was done four weeks or longer after the pills were completed to assess H pylori eradication.
Whether omeprazole was given once or twice daily, eradication was high and the same in both arms. All-patients-treated eradication was 85% (39 of 46 in the omeprazole once daily group and 41 of 48 in the omeprazole twice daily group) and intent-to-treat eradication was 80% (39 of 49 in the omeprazole once daily group and 41 of 51 in the omeprazole twice daily group). Side effects were frequently seen, suffered by 65% to 69% of patients treated. However, these were mild and compliance was high, with 94% of patients taking all of their pills. Mild side effects included loose stools, taste disturbance, nausea, headache and upper or lower gastrointestinal gas. Only one patient (1%) from the omeprazole once daily arm stopped taking metronidazole due to excessive perspiring.
In this community practice, OCM triple therapy was effective whether omeprazole was given once or twice daily. For those with financial constraint, omeprazole 20 mg once daily can be considered. The regimens were well tolerated without serious adverse events.
奥美拉唑、克拉霉素和甲硝唑三联疗法（OCM）一周疗程被全球公认为根除幽门螺杆菌的一线治疗方案。目前尚不清楚奥美拉唑应每日服用一次还是两次。
在加拿大的一个单中心实践中评估这些治疗方案的疗效和安全性。
经组织学证实为幽门螺杆菌阳性的患者，采用克拉霉素250mg每日两次和甲硝唑500mg每日两次治疗7天，并在这项开放性队列研究中随机分配至每日服用一次或两次20mg奥美拉唑组。在完成服药四周或更长时间后进行内镜检查及组织学检查（取两块胃窦和两块胃体活检组织，吉姆萨染色），以评估幽门螺杆菌根除情况。
无论奥美拉唑每日服用一次还是两次，根除率都很高且两组相同。所有接受治疗患者的根除率为85%（奥美拉唑每日一次组46例中的39例，奥美拉唑每日两次组48例中的41例），意向性治疗根除率为80%（奥美拉唑每日一次组49例中的39例，奥美拉唑每日两次组51例中的41例）。副作用常见，65%至69%接受治疗的患者出现副作用。然而，这些副作用较轻，依从性较高，94%的患者服完了所有药物。轻度副作用包括腹泻、味觉障碍、恶心、头痛以及上、下胃肠道胀气。奥美拉唑每日一次组只有1例患者（1%）因出汗过多而停止服用甲硝唑。
在本社区实践中，无论奥美拉唑每日服用一次还是两次，OCM三联疗法均有效。对于经济条件有限的患者，可考虑每日服用一次20mg奥美拉唑。这些治疗方案耐受性良好，未发生严重不良事件。
