Murakami Kazunari, Okimoto Tadayoshi, Kodama Masaaki, Sato Ryugo, Watanabe Koichiro, Fujioka Toshio
Faculty of Medicine, Department of Gastroenterology, Oita University, Oita, Japan.
J Clin Gastroenterol. 2008 Feb;42(2):139-42. doi: 10.1097/MCG.0b013e31802cbc1a.
We compared the eradication results of retreatment of eradication with proton pump inhibitor (PPI) plus amoxicillin and metronidazole for patients with Helicobacter pylori infection not eradicated by initial treatment with PPI plus amoxicillin and clarithromycin.
In Japan, the guideline proposes that the use of metronidazole in a triple therapy containing PPI, PPI plus amoxicillin and metronidazole is desirable in retreatment. However, there are no reports comparing various retreatment using different PPIs.
After initial treatment failure with a PPI plus amoxicillin and clarithromycin, 169 patients were randomized to a PPI (rabeprazole, lansoprazole, or omeprazole) plus amoxicillin and metronidazole given b.i.d. for 7 days.
Pretreatment susceptibility testing showed a high level of clarithromycin resistance (78%). The over all eradication rates were similar with the 3 PPIs, 91.1% range 90.1 to 91.4 with intention-to-treat analysis. The presence of metronidazole resistance reduced the eradication rate by approximately 40% (from 96.6% to 57.1%, P<0.05).
In Japan, the combination of a PPI plus amoxicillin and metronidazole provide excellent eradication rates after initial treatment failure with a PPI plus amoxicillin and clarithromycin. The results with metronidazole resistant strains are less satisfactory and pretreatment susceptibility testing may become needed if the prevalence of metronidazole resistant H. pylori increase.
我们比较了质子泵抑制剂（PPI）联合阿莫西林和甲硝唑对初次使用PPI联合阿莫西林和克拉霉素治疗未根除幽门螺杆菌感染患者进行再治疗的根除效果。
在日本，指南建议在再治疗中使用含PPI、PPI联合阿莫西林和甲硝唑的三联疗法。然而，尚无比较使用不同PPI进行各种再治疗的报告。
在初次使用PPI联合阿莫西林和克拉霉素治疗失败后，169例患者被随机分为接受PPI（雷贝拉唑、兰索拉唑或奥美拉唑）联合阿莫西林和甲硝唑，每日2次，共7天。
治疗前药敏试验显示克拉霉素耐药率较高（78%）。3种PPI的总体根除率相似，意向性分析显示为91.1%（范围90.1%至91.4%）。甲硝唑耐药的存在使根除率降低约40%（从96.6%降至57.1%，P<0.05）。
在日本，PPI联合阿莫西林和甲硝唑在初次使用PPI联合阿莫西林和克拉霉素治疗失败后提供了优异的根除率。甲硝唑耐药菌株的结果不太令人满意，如果甲硝唑耐药幽门螺杆菌的患病率增加，可能需要进行治疗前药敏试验。
