Avidan B, Melzer E, Keller N, Bar-Meir S
Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Israel.
Isr Med Assoc J. 2001 Mar;3(3):163-5.
Current treatment for the eradication of Helicobacter pylori in patients with peptic disease is based on the combination of antibiotic and anti-acid regimens. Multiple combinations have been investigated, however no consensus has been reached regarding the optimal duration and medications.
To assess the efficacy of two treatment regimens in patients with peptic ulcer disease and non-ulcer dyspepsia, and to determine the need for gastric mucosal culture in patients failing previous treatment.
Ninety patients with established peptic ulcer and NUD (with previously proven ulcer) were randomly assigned to receive either bismuth-subcitrate, amoxycillin and metrnidazole (BAM) or lansoprasole, clarithromycine and metronidazole (LCM) for 7 days. Patients with active peptic disease were treated with ranitidine 300 mg/day for an additional month.
Eradication failed in 8 of the 42 patients in the BAM group and in 2 of the 43 patients in the LCM group, as determined by the 13C urea breath test or rapid urease test (19% vs. 5%, respectively, P = 0.05). Five of these 10 patients were randomly assigned to treatment with lansoprazole, amoxycillin and clarithromycin (LAC) regardless of the culture obtained, and the other 5 patients were assigned to treatment with lansoprazole and two antibacterial agents chosen according to a susceptibility test. Eradication of H. pylori was confirmed by the 13C urea breath test. The same protocol (LAC) was used in all patients in the first group and in four of the five patients in the second group. The culture results did not influence the treatment protocol employed.
Combination therapy based on proton pump inhibitor and two antibiotics is superior to bismuth-based therapy for one week. Gastric-mucosal culture testing for sensitivity of H. pylori to antibiotics is probably unnecessary before the initiation of therapy for patients with eradication failure.
目前用于根除消化性疾病患者幽门螺杆菌的治疗方法是基于抗生素和抗酸方案的联合使用。已经研究了多种联合方案，然而关于最佳疗程和药物尚未达成共识。
评估两种治疗方案对消化性溃疡疾病和非溃疡性消化不良患者的疗效，并确定既往治疗失败患者进行胃黏膜培养的必要性。
90例确诊为消化性溃疡和非溃疡性消化不良（既往有溃疡病史）的患者被随机分配接受枸橼酸铋、阿莫西林和甲硝唑（BAM）或兰索拉唑、克拉霉素和甲硝唑（LCM）治疗7天。活动性消化性疾病患者加用雷尼替丁300mg/天，持续1个月。
根据13C尿素呼气试验或快速尿素酶试验，BAM组42例患者中有8例根除失败，LCM组43例患者中有2例根除失败（分别为19%和5%，P=0.05）。这10例患者中有5例无论培养结果如何，均被随机分配接受兰索拉唑、阿莫西林和克拉霉素（LAC）治疗，另外5例患者根据药敏试验结果接受兰索拉唑和两种抗菌药物治疗。通过13C尿素呼气试验确认幽门螺杆菌已被根除。第一组所有患者和第二组5例患者中的4例均采用相同方案（LAC）治疗。培养结果未影响所采用的治疗方案。
基于质子泵抑制剂和两种抗生素的联合治疗优于铋剂治疗1周。对于根除失败的患者，在开始治疗前进行幽门螺杆菌对抗生素敏感性的胃黏膜培养检测可能没有必要。
