Van Oijen A H, Verbeek A L, Jansen J B, De Boer W A
Department of Gastroenterology and Hepatology, University Medical Centre, Nijmegen, The Netherlands.
Aliment Pharmacol Ther. 2000 Aug;14(8):991-9. doi: 10.1046/j.1365-2036.2000.00798.x.
Triple therapy, combining a proton pump inhibitor with clarithromycin (C) and either amoxycillin (A) or a nitro-imidazole (I) is the standard in Helicobacter pylori eradication therapy. Recently, triple therapies based on ranitidine bismuth citrate (RBC) have emerged as an alternative. This review examines the current literature for studies directly comparing proton pump inhibitor- with RBC-based triple therapies. Seventeen studies were identified, of which three have been published as a full paper. Eradication rates in an intention-to-treat analysis ranged from 51 to 98%. No large difference in cure rates between the different regimens was demonstrated, although the RBC-I-C combination was somewhat superior. No definite conclusions could be made about the impact of metronidazole or clarithromycin resistance since only three studies performed a formal resistance analysis. No serious side-effects were reported, and dropout rates were equal for the two regimens. Both RBC- and proton pump inhibitor-based triple therapies are highly effective. If one prefers a imidazole/clarithromycin combination the evidence presented here suggests that RBC should be used instead of a proton pump inhibitor. Larger studies comparing both forms of triple therapy, using proper resistance analysis, are needed before final conclusions can be reached regarding efficacy in the setting of bacterial resistance.
三联疗法，即质子泵抑制剂联合克拉霉素（C）以及阿莫西林（A）或硝基咪唑（I），是根除幽门螺杆菌治疗的标准方法。最近，基于雷尼替丁枸橼酸铋（RBC）的三联疗法已成为一种替代方案。本综述研究了直接比较基于质子泵抑制剂和基于RBC的三联疗法的当前文献。共识别出17项研究，其中3项已作为完整论文发表。意向性分析中的根除率在51%至98%之间。尽管RBC-I-C组合略具优势，但不同治疗方案之间的治愈率没有显著差异。由于只有3项研究进行了正式的耐药性分析，因此关于甲硝唑或克拉霉素耐药性的影响无法得出明确结论。未报告严重副作用，两种治疗方案的退出率相同。基于RBC和质子泵抑制剂的三联疗法均非常有效。如果有人更喜欢咪唑/克拉霉素组合，此处提供的证据表明应使用RBC而非质子泵抑制剂。在就细菌耐药情况下的疗效得出最终结论之前，需要进行更大规模的研究，采用适当的耐药性分析来比较两种形式的三联疗法。
