基于埃索美拉唑的1周三联疗法，通过药敏试验指导根除儿童幽门螺杆菌感染。

Esomeprazole-based 1-week triple therapy directed by susceptibility testing for eradication of Helicobacter pylori infection in children.

作者信息

Arenz Tina, Antos David, Rüssmann Holger, Alberer Martin, Buderus Stefan, Kappler Matthias, Koletzko Sibylle

机构信息

Dr von Haunersches Kinderspital of the Ludwig-Maximilians University of Munich, Germany.

出版信息

J Pediatr Gastroenterol Nutr. 2006 Aug;43(2):180-4. doi: 10.1097/01.mpg.0000228103.89454.a2.

DOI:10.1097/01.mpg.0000228103.89454.a2

PMID:16877981

Abstract

BACKGROUND

Poor compliance to therapy and antibiotic resistance are the main causes for failure of anti-Helicobacter pylori therapy.

OBJECTIVE

To evaluate the effectiveness of esomeprazole-based triple therapy directed by susceptibility testing.

METHODS

Symptomatic children with H. pylori infection, who underwent successful susceptibility testing and were colonized by no double-resistant strain, received 1-week triple therapy with esomeprazole, amoxicillin and either clarithromycin or metronidazole. Success of eradication was investigated by C-urea breath test.

RESULTS

Fifty-eight children (median age, 11.4 years; range, 2.2-17.7 years; 81% immigrants) were included. Helicobacter pylori was resistant to clarithromycin in 5 (9%) and to metronidazole in 9 children (16%). Eradication was successful in 49 (92%) of 53 children receiving esomeprazole, amoxicillin and clarithromycin and in all 5 children treated with metronidazole instead of clarithromycin, resulting in an eradication rate of 93% (95% confidence interval, 83%-98%, intention-to-treat analysis). All 4 treatment failures occurred in immigrants with language problems; 2 of them were obviously noncompliant.

CONCLUSION

Esomeprazole-based 1-week triple therapy directed by susceptibility testing is highly effective for eradication of H. pylori infection in children.

摘要

背景

治疗依从性差和抗生素耐药性是抗幽门螺杆菌治疗失败的主要原因。

目的

评估基于药敏试验的埃索美拉唑三联疗法的有效性。

方法

有症状的幽门螺杆菌感染儿童，成功进行药敏试验且未被双重耐药菌株定植，接受为期1周的埃索美拉唑、阿莫西林和克拉霉素或甲硝唑三联疗法。通过C-尿素呼气试验调查根除是否成功。

结果

纳入58名儿童（中位年龄11.4岁；范围2.2 - 17.7岁；81%为移民）。5名儿童（9%）的幽门螺杆菌对克拉霉素耐药，9名儿童（16%）对甲硝唑耐药。53名接受埃索美拉唑、阿莫西林和克拉霉素治疗的儿童中有49名（92%）根除成功，5名接受甲硝唑而非克拉霉素治疗的儿童全部根除成功，意向性分析得出根除率为93%（95%置信区间，83% - 98%）。所有4例治疗失败均发生在有语言问题的移民儿童中；其中2例明显依从性差。