Isomoto H, Inoue K, Furusu H, Enjoji A, Fujimoto C, Yamakawa M, Hirakata Y, Omagari K, Mizuta Y, Murase K, Shimada S, Murata I, Kohno S
Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan.
Aliment Pharmacol Ther. 2003 Jul 1;18(1):101-7. doi: 10.1046/j.1365-2036.2003.01659.x.
There is currently no optimal second-line treatment after failure of Helicobacter pylori triple therapy.
To determine effective salvage therapy after failure of lansoprazole-amoxicillin-clarithromycin.
After failure of lansoprazole-amoxicillin-clarithromycin 123 out-patients were randomized to receive either 2-week rabeprazole (20 mg b.d.) + amoxicillin (1000 mg b.d.) (RA group) or 1-week rabeprazole (10 mg b.d.) + amoxicillin (750 mg twice b.d.) + metronidazole (250 mg b.d.) (RAM group). Eradication was assessed by the 13C-urea breath test. We also evaluated cytochrome p450 (CYP) 2C19 genotype status, determined by polymerase chain reaction - restriction fragment length polymorphism, and susceptibility to clarithromycin and metronidazole.
On an intention-to-treat basis, H. pylori infection cure was achieved in 37 of 63 (59%) patients in the RA group and in 49 of 60 (82%) patients in the RAM group. Per protocol-based eradication rates in the RA and RAM groups were 66% (37/56) and 88% (49/56), respectively. In both analytic sets there were significant differences between the treatment groups (P < 0.01 in each). Mild adverse events were observed in eight and five patients from the RA and RAM groups, respectively. Genetic predisposition of CYP2C19 and antibiotic resistance did not influence the treatment outcome either regimen.
The rabeprazole + amoxicillin + metronidazole therapy yielded satisfactory results. In contrast, the cure rate in high-dose rabeprazole + amoxicillin was below an acceptable level.
目前幽门螺杆菌三联疗法失败后尚无最佳的二线治疗方案。
确定兰索拉唑-阿莫西林-克拉霉素治疗失败后的有效补救疗法。
兰索拉唑-阿莫西林-克拉霉素治疗失败后，123例门诊患者被随机分为两组，分别接受为期2周的雷贝拉唑（20毫克，每日两次）+阿莫西林（1000毫克，每日两次）（RA组），或为期1周的雷贝拉唑（10毫克，每日两次）+阿莫西林（750毫克，每日两次）+甲硝唑（250毫克，每日两次）（RAM组）。通过13C-尿素呼气试验评估根除情况。我们还评估了通过聚合酶链反应-限制性片段长度多态性测定的细胞色素P450（CYP）2C19基因型状态，以及对克拉霉素和甲硝唑的敏感性。
在意向性治疗的基础上，RA组63例患者中有37例（59%）幽门螺杆菌感染得到治愈，RAM组60例患者中有49例（82%）治愈。基于方案的RA组和RAM组根除率分别为66%（37/56）和88%（49/56）。在两个分析组中，治疗组之间均存在显著差异（每组P<0.01）。RA组和RAM组分别有8例和5例患者出现轻度不良事件。CYP2C19的遗传易感性和抗生素耐药性均未影响两种治疗方案的治疗结果。
雷贝拉唑+阿莫西林+甲硝唑疗法取得了满意的结果。相比之下，高剂量雷贝拉唑+阿莫西林的治愈率低于可接受水平。
