Murakami K, Sato R, Okimoto T, Nasu M, Fujioka T, Kodama M, Kagawa J
Second Department of Internal Medicine, Oita Medical University, 1-1 Idaigaoka Hasama, Oita 879-5593, Japan.
Aliment Pharmacol Ther. 2003 Jan;17(1):119-23. doi: 10.1046/j.1365-2036.2003.01401.x.
The widespread use of eradication therapy for Helicobacter pylori in Japan has led to an increase in antibiotic-resistant strains and the problem of re-treatment in cases of eradication failure.
To perform drug sensitivity testing for metronidazole in 92 H. pylori-positive patients who had failed eradication treatment with first-line triple therapy, consisting of a proton pump inhibitor, amoxicillin and clarithromycin, and were administered metronidazole-containing second-line therapy.
Second-line eradication therapy, consisting of rabeprazole (20 mg b.d.), amoxicillin (750 mg b.d.) and metronidazole (250 mg b.d.), was administered for 1 week and the eradication rates and influence of metronidazole resistance were determined.
The eradication rates for rabeprazole-amoxicillin-metronidazole were 88% (81/92) using intention-to-treat analysis and 91% (81/89) using per protocol analysis. The eradication rates were 97% (61/63) for metronidazole-sensitive strains and 82% (18/22) for metronidazole-resistant strains.
As second-line H. pylori eradication treatment in Japan, rabeprazole-amoxicillin-metronidazole triple therapy is effective, even with metronidazole-resistant strains.
在日本，幽门螺杆菌根除疗法的广泛使用导致了抗生素耐药菌株的增加以及根除失败时的再治疗问题。
对92例幽门螺杆菌阳性患者进行甲硝唑药敏试验，这些患者一线三联疗法（由质子泵抑制剂、阿莫西林和克拉霉素组成）根除治疗失败，随后接受含甲硝唑的二线治疗。
给予由雷贝拉唑（20毫克，每日两次）、阿莫西林（750毫克，每日两次）和甲硝唑（250毫克，每日两次）组成的二线根除疗法，为期1周，并确定根除率和甲硝唑耐药性的影响。
采用意向性分析，雷贝拉唑-阿莫西林-甲硝唑的根除率为88%（81/92）；采用符合方案分析，根除率为91%（81/89）。甲硝唑敏感菌株的根除率为97%（61/63），甲硝唑耐药菌株的根除率为82%（18/22）。
作为日本幽门螺杆菌二线根除治疗，雷贝拉唑-阿莫西林-甲硝唑三联疗法有效，即使对于甲硝唑耐药菌株也是如此。
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