Ozdil Kamil, Calhan Turan, Sahin Abdurrahman, Senates Ebubekir, Kahraman Resul, Yüzbasioglu Bilgehan, Demirdag Hakan, Demirsoy Hüseyin, Sökmen Mehmet H
Department of Gstroenterology, Umraniye Education and Research Hospital, Istanbul, Turkey.
Hepatogastroenterology. 2011 Jul-Aug;58(109):1148-52. doi: 10.5754/hge11075.
BACKGROUND/AIMS: Development of resistance to standard therapy for Helicobacter pylori (H. pylori) eradication is rapid. The aim of this study is to compare the efficacy of alternative treatment modalities for H. pylori. Compared treatments were standard triple treatment plus probiotic, sequential therapy with levofloxacin, and a 14-day regimen of PPI (proton pump inhibitor) and levofloxacin/amoxicillin combination.
Overall 285 patients were enrolled in the study and allocated into three groups. Group I (n=98) received lansoprazole, clarithromycin, amoxicillin and saccharomyces boulardii (probiotic) and group II (n=95) received esomeprazole, levofloxacin and amoxicillin for 14 days. Finally, group III (n=92) received esomeprazole and amoxicillin for five days, followed by esomeprazole, levofloxacin and metronidazole for seven days. Testing for H. pylori infection post-treatment was done using a stool antigen test five weeks after the completion of therapy.
Patients in all three groups were treatment-naive. Response to treatment (Per Protocol/ITT analysis) was 77.1/72.4% in Group I, 89.1/86.3% in Group II, and 95.5% in Group III. Response to treatment was significantly higher in Groups II and III compared to Group I (p=0.03 and p<0.001, respectively). There was no difference between Groups II and III in terms of response to treatment (p=0.1).
Levofloxacin-based sequential therapy and levofloxacin based triple therapy were significantly superior to standard triple therapy plus probiotic.
背景/目的：幽门螺杆菌（H. pylori）根除标准疗法的耐药性发展迅速。本研究旨在比较幽门螺杆菌替代治疗方案的疗效。比较的治疗方法为标准三联疗法加益生菌、左氧氟沙星序贯疗法以及质子泵抑制剂（PPI）与左氧氟沙星/阿莫西林联合使用的14天方案。
共有285例患者纳入本研究并分为三组。第一组（n = 98）接受兰索拉唑、克拉霉素、阿莫西林和布拉酵母菌（益生菌）治疗，第二组（n = 95）接受埃索美拉唑、左氧氟沙星和阿莫西林治疗14天。最后，第三组（n = 92）先接受埃索美拉唑和阿莫西林治疗5天，随后接受埃索美拉唑、左氧氟沙星和甲硝唑治疗7天。治疗结束5周后，采用粪便抗原检测法检测治疗后幽门螺杆菌感染情况。
所有三组患者均为初治患者。按方案/意向性分析，第一组的治疗反应率为77.1%/72.4%，第二组为89.1%/86.3%，第三组为95.5%。与第一组相比，第二组和第三组的治疗反应率显著更高（分别为p = 0.03和p < 0.001）。第二组和第三组在治疗反应方面无差异（p = 0.1）。
基于左氧氟沙星的序贯疗法和基于左氧氟沙星的三联疗法显著优于标准三联疗法加益生菌。
