Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Helicobacter. 2010 Apr;15(2):148-53. doi: 10.1111/j.1523-5378.2010.00748.x.
The eradication rate of proton-pump inhibitor-based triple therapy for Helicobacter pylori infection is low due to increasing antibiotics resistance, especially clarithromycin. Recently, it was reported in Europe that a 10-day sequential strategy produced good outcomes. The aim of this study was to assess the efficacy of sequential therapy as first-line treatment for eradication of H. pylori in clinical practice in Korea.
A total of 98 patients (mean age 55.2 years and male 47, female 51) with proven H. pylori infection received 10-day sequential therapy (20 mg of rabeprazole, and 1 g of amoxicillin, twice daily for the first 5 days, followed by 20 mg of rabeprazole, 500 mg of clarithromycin, and 500 mg of metronidazole, twice daily for the remaining 5 days). Eradication was evaluated 4 weeks later, after completion of treatment by 13(C)-urea breath testing. Eradication rates were calculated by intention-to-treat (ITT) and by per protocol (PP). Compliance and adverse events were also assessed in study group.
The eradication rate of sequential therapy was 91.8% (90/98) by ITT and same result was reported by PP analysis (89/97). The study group consisted of 66 H. pylori associated gastritis, 7 gastric ulcer, and 25 duodenal ulcer patients (67.3%, 7.1%, 25.5%, respectively). Mild adverse events happened frequently (21.4%) but the treatment was well tolerable. The most common adverse event was a bitter taste (9.2%) followed by nausea and diarrhea (4.1%).
Ten-day sequential therapy is found to effectively eradicate H. pylori infection as first-line treatment in Korea.
由于抗生素耐药性的增加,尤其是克拉霉素,质子泵抑制剂三联疗法根除幽门螺杆菌的根除率较低。最近,在欧洲有报道称,10 天序贯疗法产生了良好的效果。本研究旨在评估序贯疗法作为韩国临床实践中幽门螺杆菌根除的一线治疗方法的疗效。
共有 98 例(平均年龄 55.2 岁,男性 47 例,女性 51 例)经证实的幽门螺杆菌感染患者接受了 10 天序贯治疗(前 5 天每天 2 次给予 20mg 雷贝拉唑和 1g 阿莫西林,随后 5 天每天 2 次给予 20mg 雷贝拉唑、500mg 克拉霉素和 500mg 甲硝唑)。治疗结束后 4 周,通过 13(C)-尿素呼气试验评估根除情况。通过意向治疗(ITT)和方案(PP)分析计算根除率。还评估了研究组的依从性和不良反应。
序贯疗法的根除率为 91.8%(90/98),PP 分析结果相同(89/97)。研究组包括 66 例幽门螺杆菌相关性胃炎、7 例胃溃疡和 25 例十二指肠溃疡患者(分别为 67.3%、7.1%和 25.5%)。轻度不良反应较为常见(21.4%),但治疗耐受性良好。最常见的不良反应是口苦(9.2%),其次是恶心和腹泻(分别为 4.1%)。
10 天序贯疗法被发现可有效根除幽门螺杆菌感染,作为韩国的一线治疗方法。