Ermis Fatih, Akyuz Filiz, Uyanikoglu Ahmet, Kurt Ramazan, Pinarbasi Binnur, Nazik Hasan, Kaymakoglu Sabahattin, Mungan Zeynel
Department of Gastroenterology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
South Med J. 2011 Aug;104(8):579-83. doi: 10.1097/SMJ.0b013e3182249be0.
First-line standard eradication efficacy with lansoprazole, amoxicillin and clarithromycin regressed over 10 years. The aim of this study was to evaluate the efficacy and tolerability of a levofloxacin-based regimen in patients with peptic ulcer after failure of the standard first-line H.pylori eradication therapy in a country with a high rate of infection.
A total of 91 peptic ulcer patients who were diagnosed H.pylori positive proven by rapid urease test and histology between November 2005 to March 2008 were given lansoprazole 30 mg bid, amoxicillin 1 g bid and clarithromycin 500 mg bid (LAC) for 14 days. After three months from the first line eradication treatment omeprazole 20 mg bid, levofloxacin 500 mg bid, amoxicillin 1 g bid (OLA) 7 day treatment regimen was recommended as a second-line therapy for 37 patients who failed at first-line standard triple therapy.
Eradication rates for LAC regimen were found to be 57.14% (52/91) for intention to treat and 58.42% (52/89) for per protocol analysis. Eradication rates for OLA regimen were found to be 37.83% (14/37) for ITT and 41.17% (14/34) for PP analysis.
OLA regimen eradication rate was successful only in 40% of patients who failed in the first-line eradication. New eradication treatment strategies must be performed, at least in Turkey.
兰索拉唑、阿莫西林和克拉霉素的一线标准根除疗效在10年间有所下降。本研究的目的是评估在一个感染率较高的国家，对于标准一线幽门螺杆菌根除治疗失败的消化性溃疡患者，基于左氧氟沙星的治疗方案的疗效和耐受性。
2005年11月至2008年3月期间，共有91例经快速尿素酶试验和组织学检查确诊为幽门螺杆菌阳性的消化性溃疡患者，给予兰索拉唑30mg bid、阿莫西林1g bid和克拉霉素500mg bid（LAC）治疗14天。在一线根除治疗三个月后，对于37例一线标准三联疗法失败的患者，推荐使用奥美拉唑20mg bid、左氧氟沙星500mg bid、阿莫西林1g bid（OLA）的7天治疗方案作为二线治疗。
LAC方案的意向性治疗根除率为57.14%（52/91），符合方案分析的根除率为58.42%（52/89）。OLA方案的意向性治疗根除率为37.83%（14/37），符合方案分析的根除率为41.17%（14/34）。
OLA方案仅在40%的一线根除失败患者中取得成功。至少在土耳其，必须采用新的根除治疗策略。
