Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Aliment Pharmacol Ther. 2011 Sep;34(6):604-17. doi: 10.1111/j.1365-2036.2011.04770.x. Epub 2011 Jul 11.
Traditional standard triple therapy for Helicobacter pylori infection (PPI-clarithromycin-amoxicillin) can easily be converted to non-bismuth quadruple (concomitant) therapy by the addition of a nitroimidazole twice daily.
To critically review evidence on the role of non-bismuth quadruple therapy (PPI-clarithromycin-amoxicillin-nitroimidazole) in the treatment of H. pylori infection.
Bibliographical searches were performed in MEDLINE and relevant congresses.
The first randomised comparison of the non-bismuth quadruple therapy and the sequential (PPI-amoxicillin 5days plus PPI-clarithromycin-nitroimidazole 5days) regimens recently concluded that both were similar in terms of efficacy and safety and that the sequential administration protocol may be unnecessarily complex. Several randomised controlled trials (and one meta-analysis) have demonstrated that non-bismuth quadruple therapy is more effective than and is equally well tolerated as standard triple therapy. A meta-analysis of 15 studies (1723 patients) revealed a mean H. pylori cure rate (intention-to-treat) of 90% for non-bismuth quadruple therapy. A tendency towards better results with longer treatments (7-10days vs. 3-5days) has been observed, so it seems reasonable to recommend the length of treatment by achieving maximal cure rates (10days). Clarithromycin resistance may reduce the efficacy of non-bismuth quadruple therapy, although the decrease in eradication rates seems to be far lower than in standard triple therapy. Experience with the non-bismuth quadruple therapy in patients with metronidazole-resistant strains is still very limited.
Non-bismuth quadruple (concomitant) therapy appears to be an effective, safe, and well-tolerated alternative to triple therapy and is less complex than sequential therapy. Therefore, this regimen appears well suited for use in settings where the efficacy of triple therapy is unacceptably low.
幽门螺杆菌感染的传统三联标准疗法（质子泵抑制剂-克拉霉素-阿莫西林）可通过每日两次添加硝基咪唑轻松转换为非铋四联（同时）疗法。
批判性地回顾非铋四联疗法（质子泵抑制剂-克拉霉素-阿莫西林-硝基咪唑）在幽门螺杆菌感染治疗中的作用。
在 MEDLINE 和相关会议上进行文献检索。
最近首次对非铋四联疗法和序贯（质子泵抑制剂-阿莫西林 5 天加质子泵抑制剂-克拉霉素-硝基咪唑 5 天）方案进行了随机比较，结果表明这两种方案在疗效和安全性方面相似，且序贯给药方案可能过于复杂。几项随机对照试验（和一项荟萃分析）已经证明，非铋四联疗法比标准三联疗法更有效且耐受性相同。对 15 项研究（1723 名患者）的荟萃分析显示，非铋四联疗法的幽门螺杆菌治愈率（意向治疗）为 90%。观察到治疗时间较长（7-10 天与 3-5 天）的效果趋势更好，因此根据实现最大治愈率（10 天）来推荐治疗时间似乎是合理的。克拉霉素耐药可能会降低非铋四联疗法的疗效，尽管根除率的降低似乎远低于标准三联疗法。非铋四联疗法在甲硝唑耐药菌株患者中的应用经验仍然非常有限。
非铋四联（同时）疗法似乎是三联疗法的有效、安全且耐受良好的替代方案，且比序贯疗法更简单。因此，该方案似乎非常适合在三联疗法疗效不可接受的情况下使用。
