Tursi A, Elisei W, Giorgetti G, Picchio M, Brandimarte G
Gastroenterology Service, ASL BAT, Andria, Barletta-Andria-Trani, Italy -
Panminerva Med. 2014 Mar;56(1):57-61.
The aim of the present study was to assess the efficacy of the standard triple therapy containing PPI plus amoxycillin and clarithromycin in curing Helicobacter pylori (H. pylori) infection during a long-term period.
A retrospective analysis was conducted on 1497 consecutive dyspeptic patients with proven H. pylori infection and enrolled from 1996 to 2006. Patients received a standard triple therapy with proton pump inhibitor (PPI) plus amoxicillin 1 g and clarithromycin 500 mg for 7 days (all twice daily) plus PPI every day for further 4 weeks in case of active peptic ulcer or severe gastritis detected at endoscopy. One month after conclusion of therapy, endoscopy was performed in those patients for whom the examinations were clinically relevant. The remaining patients were checked by ¹³C-urea breath test.
The overall H. pylori eradication rate was 70.41% (on intention-to-treat analysis). However, it decreased significantly during the observation period, ranging from 90% (95% CI 87.14% to 93.91%) in 1996 to 51.11% (95% CI 48.14% to 55.91%) in 2006 (on i-t-t analysis) (P=0.001). No difference in eradicating the was found infection between Puglia and Lazio (1996: P=0.39; 2006: P=0.64).
Standard triple therapy does not appear anymore a valid therapeutic strategy for the management of H. pylori infection in clinical practice.
本研究旨在评估含质子泵抑制剂（PPI）加阿莫西林和克拉霉素的标准三联疗法长期治疗幽门螺杆菌（H. pylori）感染的疗效。
对1996年至2006年连续纳入的1497例经证实感染H. pylori的消化不良患者进行回顾性分析。患者接受质子泵抑制剂（PPI）加1 g阿莫西林和500 mg克拉霉素的标准三联疗法，疗程7天（均每日2次），若内镜检查发现活动性消化性溃疡或严重胃炎，则继续每日服用PPI 4周。治疗结束1个月后，对那些临床检查有必要的患者进行内镜检查。其余患者通过¹³C - 尿素呼气试验进行检查。
在意向性分析中，总体H. pylori根除率为70.41%。然而，在观察期内该根除率显著下降，从1996年的90%（95%可信区间87.14%至93.91%）降至2006年的51.11%（95%可信区间48.14%至55.91%）（在意向性分析中）（P = 0.001）。普利亚大区和拉齐奥大区在根除感染方面未发现差异（1996年：P = 0.39；2006年：P = 0.64）。
在临床实践中，标准三联疗法似乎不再是治疗H. pylori感染的有效治疗策略。
