Gasbarrini Antonio, Lauritano Ernesto Cristiano, Nista Enrico Celestino, Candelli Marcello, Gabrielli Maurizio, Santoro Michele, Zocco Maria Assunta, Cazzato Alessia, Finizio Rosalba, Ojetti Veronica, Cammarota Giovanni, Gasbarrini Giovanni
Department of Internal Medicine, Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy.
Dig Dis. 2006;24(1-2):195-200. doi: 10.1159/000090330.
Triple therapy is the treatment of choice for Helicobacter pylori-infected patients with an eradication rate ranging from 70 to 85%. Poor compliance and antibiotic resistance are the main causes of treatment failure. The aim of the present study was to assess the efficacy of rifaximin, a poorly absorbed antibiotic, for H. pylori eradication.
We enrolled 48 consecutive H. pylori-positive patients affected. They were randomized to receive two 7-day rifaximin-based triple therapies: rifaximin tablets 400 mg t.i.d., esomeprazole 40 mg o.d. and clarithromycin 500 mg b.i.d. (CRE) or levofloxacin 500 mg o.d. (LRE). H. pylori eradication was assessed using a (13)C-urea breath test 4 weeks after the end of therapy. Treatment compliance and the incidence of side effects were also evaluated.
No dropouts were observed. The eradication rate both on intention-to-treat and per-protocol analysis did not show significant differences between groups: 58% (14/24 patients) in group 1 and 42% (10/24 patients) in group 2 (p = 0.24, OR 1.96, 95% CI 0.62-6.18). No significant differences in patients' compliance and incidence of side effects were found between groups.
Rifaximin-based therapy showed optimal compliance but a limited eradication rate compared to standard first-line treatment. Further investigations are needed to evaluate different dosages and combinations.
三联疗法是幽门螺杆菌感染患者的首选治疗方法，根除率在70%至85%之间。依从性差和抗生素耐药是治疗失败的主要原因。本研究的目的是评估利福昔明（一种吸收不良的抗生素）对幽门螺杆菌根除的疗效。
我们连续纳入了48例受幽门螺杆菌感染的患者。他们被随机分为接受两种基于利福昔明的7天三联疗法：利福昔明片400毫克，每日三次，埃索美拉唑40毫克，每日一次，克拉霉素500毫克，每日两次（CRE）或左氧氟沙星500毫克，每日一次（LRE）。在治疗结束后4周，使用碳-13尿素呼气试验评估幽门螺杆菌的根除情况。还评估了治疗依从性和副作用发生率。
未观察到脱落病例。在意向性分析和符合方案分析中，两组的根除率均无显著差异：第1组为58%（14/24例患者），第2组为42%（10/24例患者）（p = 0.24，OR 1.96，95%CI 0.62 - 6.18）。两组患者的依从性和副作用发生率无显著差异。
与标准一线治疗相比，基于利福昔明的疗法显示出最佳的依从性，但根除率有限。需要进一步研究以评估不同的剂量和组合。
