Department of Gastroenterology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey.
Helicobacter. 2012 Apr;17(2):121-6. doi: 10.1111/j.1523-5378.2011.00924.x.
Sequential treatment for Helicobacter pylori (H. pylori) appears to achieve a better eradication rate than triple therapy. However, most of the data have been reported from the Italy, and studies from different population are needed before it is recommended in clinical practice. The present study aimed to assess and compare the efficacy of two separate clarithromycin including sequential regimens in Turkey which is well known with high clarithromycin and metronidazole resistance to H. pylori.
Consecutive H. pylori -positive patients with non-ulcer dyspepsia were randomly allocated to one of the two sequential regimens; the first group was given lansoprazole 30 mg b.i.d. plus amoxicillin 1 g b.i.d. for the first week, followed by lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., and metronidazole 500 mg t.i.d. for the second week (LA-CM). The second arm was given the same regimen but tetracycline500 g q.i.d. instead of metronidazole (LA-CT). H. pylori was detected with urea breath test (UBT) and histology before enrollment. UBT was repeated at 6th weeks after treatment.
A total of 200 patients were enrolled in groups and 179 of them completed their protocols. The cumulative per protocol ("PP") and intention-to-treat ("ITT") eradication rates were 74.3% and 66.5% in all patients, respectively. Both "PP" (78.2% vs 70.1%) and "ITT" (72% vs 61%) eradication rates were better in LA-CT group than LA-CM group, but the differences were not statistically significant (p > .05). Both regimens were well tolerated, and the incidence of adverse effects was comparable.
Two weeks clarithromycin including sequential regimens with metronidazole or tetracycline were not achieved acceptable eradication rates in Turkey.
与三联疗法相比，序贯疗法似乎能提高幽门螺杆菌（H. pylori）的根除率。然而，大部分数据均来自意大利，在推荐序贯疗法用于临床实践之前，还需要来自不同人群的研究数据。本研究旨在评估和比较两种不同的含克拉霉素的序贯疗法在土耳其的疗效，土耳其的幽门螺杆菌对克拉霉素和甲硝唑的耐药率较高。
连续入组非溃疡性消化不良且 H. pylori 阳性的患者，随机分为两组接受不同的序贯疗法：第一组接受兰索拉唑 30mg，每日 2 次+阿莫西林 1g，每日 2 次治疗 1 周，然后给予兰索拉唑 30mg，每日 2 次+克拉霉素 500mg，每日 2 次+甲硝唑 500mg，每日 3 次治疗 2 周（LA-CM 组）；第二组接受相同的方案，但用四环素 500mg，每日 4 次代替甲硝唑（LA-CT 组）。入组前通过尿素呼气试验（UBT）和组织学检测 H. pylori。治疗结束后 6 周时重复 UBT。
共纳入 200 例患者，179 例完成了方案。所有患者的累积方案（PP）和意向治疗（ITT）根除率分别为 74.3%和 66.5%。PP 根除率（78.2% vs 70.1%）和 ITT 根除率（72% vs 61%）LA-CT 组均优于 LA-CM 组，但差异无统计学意义（p＞0.05）。两种方案均耐受良好，不良反应发生率相当。
在土耳其，2 周含克拉霉素的序贯疗法联合甲硝唑或四环素未能达到可接受的根除率。
