Molina-Infante Javier, Gisbert Javier P
Servicio de Aparato Digestivo, Hospital San Pedro de Alcántara, Cáceres, España.
Gastroenterol Hepatol. 2013 Jun-Jul;36(6):375-81. doi: 10.1016/j.gastrohep.2013.02.006. Epub 2013 Apr 25.
Triple therapy, which remains the standard treatment for Helicobacter pylori infection, should be discouraged when its efficacy is lower than 80% or when clarithromycin resistance rates are above 15-20%.
To update the available evidence on the effectiveness of triple therapy and clarithromycin resistance rates in adults in Spain over the last 6 years.
A literature search (2007-2012) was conducted in Medline and the abstracts books of the annual meetings of several Spanish gastroenterological and microbiological congresses. The search terms were « Helicobacter pylori », « Spain » and « clarithromycin ». Studies were selected if they included triple therapy consisting of a proton pump inhibitor with clarithromycin and amoxicillin or if they analyzed H. pylori clarithromycin susceptibility in treatment-naïve patients.
There were five articles and nine abstracts (3147 patients) on triple therapy, which showed a mean cure rate of 70.8% (95% CI = 66-76%). When stratified by the duration of therapy, the mean cure rates were 68.8% (60-76%) for 7-day regimens and 71.76% (68-78%) for 10-day regimens. For clarithromycin resistance rates, four articles and five abstracts (1709 patients) revealed a mean resistance rate of 18.3% (13-22%).
The efficacy of triple therapy seems to be unacceptable in recent studies conducted in Spain, possibly associated with clarithromcyin resistance rates higher than previously reported.
三联疗法仍是幽门螺杆菌感染的标准治疗方法，但当疗效低于80%或克拉霉素耐药率高于15%-20%时，应避免使用。
更新过去6年西班牙成人三联疗法有效性及克拉霉素耐药率的现有证据。
在Medline以及西班牙胃肠病学和微生物学大会年会的摘要集中进行文献检索（2007 - 2012年）。检索词为“幽门螺杆菌”、“西班牙”和“克拉霉素”。若研究包括由质子泵抑制剂、克拉霉素和阿莫西林组成的三联疗法，或分析初治患者的幽门螺杆菌克拉霉素敏感性，则将其纳入。
有5篇文章和9篇摘要（共3147例患者）涉及三联疗法，其平均治愈率为70.8%（95%可信区间 = 66 - 76%）。按治疗疗程分层时，7天疗程的平均治愈率为68.8%（60 - 76%），10天疗程的平均治愈率为71.76%（68 - 78%）。关于克拉霉素耐药率，4篇文章和5篇摘要（1709例患者）显示平均耐药率为18.3%（13 - 22%）。
在西班牙近期开展的研究中，三联疗法的疗效似乎难以接受，可能与高于先前报道的克拉霉素耐药率有关。
