Zullo A, Gatta L, De Francesco V, Hassan C, Ricci C, Bernabucci V, Cavina M, Ierardi E, Morini S, Vaira D
Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.
Aliment Pharmacol Ther. 2005 Jun 15;21(12):1419-24. doi: 10.1111/j.1365-2036.2005.02519.x.
Helicobacter pylori eradication rates with triple therapies are decreasing, and few data in elderly patients are available. A 10-day sequential regimen succeeded in curing such H. pylori infection in unselected patients.
To compare this sequential regimen and the standard triple therapy for H. pylori eradication in geriatric patients with peptic ulcer.
Overall, 179 H. pylori-infected patients with peptic ulcer were enrolled (mean age: 69.5 years; range: 65-83). Patients were randomized to 10-day sequential therapy (rabeprazole 20 mg b.d. plus amoxicillin 1 g b.d. for the first 5 days, followed by rabeprazole 20 mg, clarithromycin 500 mg and tinidazole 500 mg, all b.d., for the remaining 5 days) or standard 7-day triple regimen (rabeprazole 20 mg, clarithromycin 500 mg and amoxicillin 1 g, all b.d.). Helicobacter pylori status was assessed by histology and rapid urease test at baseline and 4-6 weeks after completion of treatment.
The sequential regimen achieved eradication rates significantly higher in comparison with the standard regimen at both intention-to-treat (94% vs. 80%; P = 0.008) and per-protocol (97% vs. 83%; P = 0.006) analyses. In both treatment groups, compliance to the therapy was high (> 95%), and the rate of mild side-effects was similarly low (< 12%). At repeated upper endoscopy, peptic ulcer lesions were healed in 97% patients, without a statistically significant difference between the sequential regimen and the standard triple therapy.
In elderly patients with peptic ulcer disease, the 10-day sequential treatment regimen achieved significantly higher eradication rates in comparison with standard triple therapy.
三联疗法根除幽门螺杆菌的成功率正在下降，而关于老年患者的数据较少。一种为期10天的序贯疗法成功治愈了未经选择的患者的幽门螺杆菌感染。
比较这种序贯疗法和标准三联疗法对老年消化性溃疡患者幽门螺杆菌的根除效果。
总共纳入了179例幽门螺杆菌感染的消化性溃疡患者（平均年龄：69.5岁；范围：65 - 83岁）。患者被随机分为接受为期10天的序贯疗法（前5天雷贝拉唑20 mg每日2次加阿莫西林1 g每日2次，随后5天雷贝拉唑20 mg、克拉霉素500 mg和替硝唑500 mg，均每日2次）或标准7天三联疗法（雷贝拉唑20 mg、克拉霉素500 mg和阿莫西林1 g，均每日2次）。在基线以及治疗完成后4 - 6周，通过组织学和快速尿素酶试验评估幽门螺杆菌感染状况。
在意向性分析（94%对80%；P = 0.008）和符合方案分析（97%对83%；P = 0.006）中，序贯疗法的根除率均显著高于标准疗法。在两个治疗组中，治疗依从性都很高（> 95%），轻度副作用发生率同样较低（< 12%）。在重复进行的上消化道内镜检查中，97%的患者消化性溃疡病变愈合，序贯疗法和标准三联疗法之间无统计学显著差异。
在老年消化性溃疡患者中，为期10天的序贯治疗方案相比标准三联疗法根除率显著更高。
