Schrauwen R W M, Janssen M J R, de Boer W A
Department of Internal Medicine and Gastroenterology, Bernhoven Hospital, Oss, the Netherlands.
Neth J Med. 2009 Mar;67(3):96-101.
Helicobacter pylori infection causes lifelong gastritis and is associated with the development of peptic ulcer disease, MALT lymphoma and gastric cancer. Many patients benefit from H. pylori eradication therapy. PPI-triple therapy is recommended as initial therapy. Quadruple therapy, with a PPI, bismuth, and two antibiotics, used to be recommended as second-line therapy, but can no longer be prescribed because bismuth is no longer available. Therefore, there is an urgent need for new effective rescue therapies. Levofloxacin-based therapies were suggested as an alternative to quadruple therapy. The aim of this study is to examine the efficacy and tolerability of such a one-week therapy with levofloxacin and esomeprazole combined with either amoxicillin or clarithromycin in a Dutch population.
Between February 2005 and November 2006, 123 consecutive H. pylori positive patients were enrolled in this study. The first 59 patients were treated with esomeprazole, amoxicillin and levofloxacin (group I). The next 64 patients were treated with esomeprazole, clarithromycin, and levofloxacin (group II ). Both therapies were compared for efficacy and tolerability.
In group I the overall (ITT) cure rate was 96% and in group II it was 93%. Minor side effects occurred in 29% of patients in group I and in 41% of patients in group II. Major side effects that warranted discontinuation of therapy occurred in two patients in group II.
Seven-day triple therapy with esomeprazole, levofloxacin and either amoxicillin or clarithromycin for seven days is very effective and safe for H. pylori eradication. The combination with amoxicillin seems to be better tolerated than the combination with clarithromycin.
幽门螺杆菌感染可导致终身性胃炎，并与消化性溃疡病、黏膜相关淋巴组织淋巴瘤及胃癌的发生有关。许多患者可从幽门螺杆菌根除治疗中获益。质子泵抑制剂三联疗法被推荐为初始治疗方案。含质子泵抑制剂、铋剂及两种抗生素的四联疗法曾被推荐为二线治疗方案，但由于铋剂已不再可用，故不再适用。因此，迫切需要新的有效补救疗法。基于左氧氟沙星的疗法被建议作为四联疗法的替代方案。本研究旨在探讨在荷兰人群中，左氧氟沙星与埃索美拉唑联合阿莫西林或克拉霉素进行为期一周的治疗方案的疗效及耐受性。
2005年2月至2006年11月期间，123例连续的幽门螺杆菌阳性患者纳入本研究。前59例患者接受埃索美拉唑、阿莫西林和左氧氟沙星治疗（I组）。接下来的64例患者接受埃索美拉唑、克拉霉素和左氧氟沙星治疗（II组）。比较两种疗法的疗效和耐受性。
I组的总体（意向性分析）治愈率为96%，II组为93%。I组29%的患者出现轻微副作用，II组41%的患者出现轻微副作用。II组有两名患者出现需要停药的严重副作用。
埃索美拉唑、左氧氟沙星联合阿莫西林或克拉霉素进行为期七天的三联疗法对于根除幽门螺杆菌非常有效且安全。与克拉霉素联合相比，与阿莫西林联合似乎耐受性更好。
