Department of Gastroenterology, Shanghai Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Jiaotong University School of Medicine, China.
Helicobacter. 2010 Jun;15(3):233-8. doi: 10.1111/j.1523-5378.2010.00758.x.
The success rate of currently recommended 7-day triple therapy with a PPI plus amoxicillin and clarithromycin has fallen into the unacceptable range. It is urgent to look for a new strategy to treat the infection of Helicobacter pylori.
To observe the efficacy of triple therapy-based, bismuth-containing quadruple therapy for H. pylori treatment.
A total of 160 patients with functional dyspepsia who were Hp+ were randomly assigned into two groups. Regimen: Omeprazole 20 mg, Amoxicillin 1.0 g, Clarithromycin 500 mg and Bismuth Potassium Citrate 220 mg, twice a day. Eighty patients received 7-day quadruple therapy and 80 patients received the same therapy for 14 days. Six weeks after treatment, H. pylori eradication was assessed by (13)C-urea breath test. Minimal inhibitory concentrations of metronidazole, clarithromycin and amoxicillin of clinical isolates were determined by the twofold agar dilution method.
Fourteen-day therapy led to a significant increase of H. pylori eradication success when compared to 7-day therapy in the intention-to-treat analysis (93.7 vs 80.0%; p = .01), and the per-protocol analysis (97.4 vs 82.0%; p = .0016). The H. pylori resistance rates to metronidazole, clarithromycin and amoxicillin were 42.1, 18.0 and 0%. Fourteen-day therapy was significantly more effective in patients with clarithromycin-resistant strains. Incidences of adverse events were comparable.
Addition bismuth and prolonging treatment duration can overcome H. pylori resistance to clarithromycin and decrease the bacterial load. Fourteen-day triple therapy-based, bismuth-containing quadruple therapy achieved ITT success rate 93% and could be recommended as the first line eradication regimen.
目前推荐的质子泵抑制剂加阿莫西林和克拉霉素 7 天三联疗法的成功率已经下降到不可接受的范围。急需寻找一种新的策略来治疗幽门螺杆菌感染。
观察基于三联疗法的含铋四联疗法治疗幽门螺杆菌的疗效。
将 160 例功能性消化不良且 Hp+患者随机分为两组。方案：奥美拉唑 20mg，阿莫西林 1.0g，克拉霉素 500mg，枸橼酸铋钾 220mg，每日 2 次。80 例患者接受 7 天四联疗法，80 例患者接受相同疗法 14 天。治疗 6 周后，通过（13）C-尿素呼气试验评估 H. pylori 根除情况。采用二倍琼脂稀释法测定临床分离株甲硝唑、克拉霉素和阿莫西林的最低抑菌浓度。
意向治疗分析中，14 天治疗组 H. pylori 根除成功率显著高于 7 天治疗组（93.7% vs 80.0%；p =.01），且符合方案分析（97.4% vs 82.0%；p =.0016）。甲硝唑、克拉霉素和阿莫西林对 H. pylori 的耐药率分别为 42.1%、18.0%和 0%。14 天治疗组对克拉霉素耐药菌株的疗效明显更好。不良反应发生率相当。
添加铋剂和延长治疗时间可以克服幽门螺杆菌对克拉霉素的耐药性，降低细菌负荷。基于三联疗法的 14 天含铋四联疗法的 ITT 成功率为 93%，可作为一线根除方案。
