Sugimoto Mitsushige, Uotani Takahiro, Sahara Shu, Ichikawa Hitomi, Yamade Mihoko, Sugimoto Ken, Furuta Takahisa
First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.
Helicobacter. 2014 Aug;19(4):312-8. doi: 10.1111/hel.12128. Epub 2014 Apr 1.
Insufficient acid inhibition during Helicobacter pylori eradication treatment and bacterial resistance to antibiotics often causes eradication failure. Four times daily dosing (q.i.d.) of a proton-pump inhibitor (PPI) achieves potent acid inhibition, suggesting its potential usefulness as a regimen for eradicating H. pylori infection. Therefore, a tailored eradication regimen based on antibiotic susceptibility and maintenance of acid inhibition should have a high success rate. We investigated the efficacy of such treatment based on clarithromycin (CAM) susceptibility.
Using 153 H. pylori-positive Japanese patients, we investigated the efficacy of tailored eradication strategy: (1) Patients infected with CAM-sensitive H. pylori were treated with a PPI (rabeprazole 10 mg q.i.d.), amoxicillin 500 mg q.i.d., and CAM 200 mg b.i.d. (n = 89), and (2) patients infected with CAM-resistant were given the same doses of rabeprazole and amoxicillin and metronidazole 250 mg b.i.d. (n = 64) for 1 week.
In the tailored regimen group, the overall eradication rate was 96.7% (95% CI: 92.5-98.9%, 148/153) in the intention-to-treat (ITT) analysis and 97.4% (93.4-99.3%, 148/152) in the PP analysis. The eradication rates for the CAM- and metronidazole-based treatments were similar (95.5% and 98.4%, respectively, p = .400). The tailored treatment achieved a high eradication rate in CYP2C19 rapid metabolizers who were a resistance genotype for PPI treatment (94.3% (86.0-98.4%, 66/70)).
A tailored H. pylori eradication regimen based on CAM susceptibility and maintaining acid secretion (rabeprazole 10 mg q.i.d.) is useful because it can achieve an eradication rate exceeding 95%, irrespective of eradication history, thus overcoming differences among CYP2C19 genotypes.
幽门螺杆菌根除治疗期间抑酸不足以及细菌对抗生素耐药常导致根除失败。质子泵抑制剂（PPI）每日四次给药可实现强效抑酸，提示其作为根除幽门螺杆菌感染方案可能有用。因此，基于抗生素敏感性和维持抑酸的定制根除方案应具有较高成功率。我们基于克拉霉素（CAM）敏感性研究了此类治疗的疗效。
我们使用153例幽门螺杆菌阳性的日本患者，研究了定制根除策略的疗效：（1）感染CAM敏感幽门螺杆菌的患者接受PPI（雷贝拉唑10 mg，每日四次）、阿莫西林500 mg，每日四次和CAM 200 mg，每日两次治疗（n = 89），以及（2）感染CAM耐药的患者给予相同剂量的雷贝拉唑和阿莫西林以及甲硝唑250 mg，每日两次（n = 64），治疗1周。
在意向性治疗（ITT）分析中，定制方案组的总体根除率为96.7%（95%CI：92.5 - 98.9%，148/153），在符合方案（PP）分析中为97.4%（93.4 - 99.3%，148/152）。基于CAM和甲硝唑治疗的根除率相似（分别为95.5%和98.4%，p = 0.400）。定制治疗在作为PPI治疗耐药基因型的CYP2C19快速代谢者中实现了高根除率（94.3%（86.0 - 98.4%，66/70））。
基于CAM敏感性并维持胃酸分泌（雷贝拉唑10 mg，每日四次）的定制幽门螺杆菌根除方案是有用的，因为它可以实现超过95%的根除率，无论根除史如何，从而克服CYP2C19基因型之间的差异。
