在两次根除治疗失败后进行经验性幽门螺杆菌“挽救”治疗。

Empirical Helicobacter pylori "rescue" therapy after failure of two eradication treatments.

作者信息

Gisbert J P, Gisbert J L, Marcos S, Pajares J M

机构信息

Department of Gastroenterology, La Princesa University Hospital, Madrid, Spain.

出版信息

Dig Liver Dis. 2004 Jan;36(1):7-12. doi: 10.1016/j.dld.2003.09.018.

DOI:10.1016/j.dld.2003.09.018

PMID:14971810

Abstract

AIM

Even with the current most effective Helicobacter pylori treatment regimens, approximately 20% of patients do not eradicate the infection. Several "rescue" therapies have been recommended, but they still fail to eradicate H. pylori in approximately 20-30% of the cases. Our aim was to evaluate the efficacy of different rescue therapies prescribed to patients in whom two consecutive H. pylori eradication regimens had failed.

METHODS

Design. Prospective single-centre study. Patients. Consecutive patients in whom two eradication regimens had failed to eradicate H. pylori. Intervention. Third eradication regimens included: (1) omeprazole-amoxicillin-clarithromycin for 7 days; (2) quadruple therapy with omeprazole-bismuth-tetracycline-metronidazole for 7 days; (3) omeprazole-amoxicillin-clarithromycin-bismuth for 14 days; and (4) omeprazole-amoxicillin-rifabutin for 14 days. H. pylori antibiotic susceptibility was unknown and, therefore, rescue regimens were chosen empirically. In no case, was the same regimen repeated. Outcome. H. pylori eradication was defined as a negative in 13C-urea breath test 8 weeks after completing the therapy.

RESULTS

Forty-eight patients were included (mean age 45 years, 44% males, 82% with peptic ulcer and 18% with functional dyspepsia). No patient was lost from follow-up. Adverse effects were described in 21% of the patients. One patient receiving omeprazole, amoxicillin and rifabutin was removed from medication due to adverse effects (vomiting). Overall, mean H. pylori eradication with third therapy after failure of two eradication treatments was 34/48 (71%; 95% confidence interval 57-82%) by intention-to-treat and 34/47 (72%; 95% confidence interval 58-83%) by per-protocol.

CONCLUSION

It seems that performing culture even after a second eradication failure may not be necessary, as it is possible to construct an overall strategy to maximise H. pylori eradication, based on the different possibilities of empirical treatment.

摘要

目的

即便采用当前最有效的幽门螺杆菌治疗方案，仍有大约20%的患者无法根除感染。已有多种“补救”疗法被推荐，但在大约20%-30%的病例中，这些疗法仍无法根除幽门螺杆菌。我们的目的是评估为连续两次幽门螺杆菌根除方案失败的患者开具的不同补救疗法的疗效。

方法

设计。前瞻性单中心研究。患者。连续两次根除方案未能根除幽门螺杆菌的患者。干预。第三种根除方案包括：（1）奥美拉唑-阿莫西林-克拉霉素，疗程7天；（2）奥美拉唑-铋剂-四环素-甲硝唑四联疗法，疗程7天；（3）奥美拉唑-阿莫西林-克拉霉素-铋剂，疗程14天；以及（4）奥美拉唑-阿莫西林-利福布汀，疗程14天。幽门螺杆菌的抗生素敏感性未知，因此，补救方案是经验性选择的。在任何情况下，都不会重复相同的方案。结局。幽门螺杆菌根除定义为治疗完成8周后13C-尿素呼气试验结果为阴性。

结果

纳入48例患者（平均年龄45岁，44%为男性，82%患有消化性溃疡，18%患有功能性消化不良）。无患者失访。21%的患者出现了不良反应。一名接受奥美拉唑、阿莫西林和利福布汀治疗的患者因不良反应（呕吐）停药。总体而言，两次根除治疗失败后采用第三种疗法的意向性分析中，幽门螺杆菌根除率为34/48（71%；95%置信区间57-82%），符合方案分析中为34/47（72%；95%置信区间58-83%）。