在标准三联或非铋剂四联疗法失败后，采用为期两周的高剂量质子泵抑制剂、莫西沙星三联疗法治疗幽门螺杆菌。

Two-week, high-dose proton pump inhibitor, moxifloxacin triple Helicobacter pylori therapy after failure of standard triple or non-bismuth quadruple treatments.

作者信息

Gisbert Javier P, Romano Marco, Molina-Infante Javier, Lucendo Alfredo J, Medina Enrique, Modolell Inés, Rodríguez-Tellez Manuel, Gomez Blas, Barrio Jesús, Perona Monica, Ortuño Juan, Ariño Inés, Domínguez-Muñoz Juan Enrique, Perez-Aisa Ángeles, Bermejo Fernando, Domínguez Jose Luis, Almela Pedro, Gomez-Camarero Judith, Millastre Judith, Martin-Noguerol Elisa, Gravina Antonietta G, Martorano Marco, Miranda Agnese, Federico Alessandro, Fernandez-Bermejo Miguel, Angueira Teresa, Ferrer-Barcelo Luis, Fernández Nuria, Marín Alicia C, McNicholl Adrián G

机构信息

Univeristy Hospital La Princesa, Instituto de Investigación Sanitaria Princesa and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Spain.

University Hospital, Seconda University of Naples, Naples, Italy.

出版信息

Dig Liver Dis. 2015 Feb;47(2):108-13. doi: 10.1016/j.dld.2014.10.009. Epub 2014 Nov 11.

DOI:10.1016/j.dld.2014.10.009

PMID:25454706

Abstract

BACKGROUND

Aim was to evaluate the efficacy and tolerability of a moxifloxacin-containing second-line triple regimen in patients whose previous Helicobacter pylori eradication treatment failed.

METHODS

Prospective multicentre study including patients in whom a triple therapy or a non-bismuth-quadruple-therapy failed. Moxifloxacin (400mg qd), amoxicillin (1g bid), and esomeprazole (40 mg bid) were prescribed for 14 days. Eradication was confirmed by (13)C-urea-breath-test. Compliance was determined through questioning and recovery of empty medication envelopes.

RESULTS

250 patients were consecutively included (mean age 48 ± 15 years, 11% with ulcer). Previous (failed) therapy included: standard triple (n = 179), sequential (n = 27), and concomitant (n = 44); 97% of patients took all medications, 4 were lost to follow-up. Intention-to-treat and per-protocol eradication rates were 82.4% (95% CI, 77-87%) and 85.7% (95% CI, 81-90%). Cure rates were similar independently of diagnosis (ulcer, 77%; dyspepsia, 82%) and previous treatment (standard triple, 83%; sequential, 89%; concomitant, 77%). At multivariate analysis, only age was associated with eradication (OR = 0.957; 95% CI, 0.933-0.981). Adverse events were reported in 25.2% of patients: diarrhoea (9.6%), abdominal pain (9.6%), and nausea (9.2%).

CONCLUSION

14-day moxifloxacin-containing triple therapy is an effective and safe second-line strategy in patients whose previous standard triple therapy or non-bismuth quadruple (sequential or concomitant) therapy has failed, providing a simple alternative to bismuth quadruple regimen.

摘要

背景

目的是评估含莫西沙星的二线三联疗法对既往幽门螺杆菌根除治疗失败患者的疗效和耐受性。

方法

前瞻性多中心研究，纳入三联疗法或非铋剂四联疗法失败的患者。给予莫西沙星（400mg，每日一次）、阿莫西林（1g，每日两次）和埃索美拉唑（40mg，每日两次），疗程14天。通过（13）C-尿素呼气试验确认根除情况。通过询问和回收空药袋确定依从性。

结果

连续纳入250例患者（平均年龄48±15岁，11%有溃疡）。既往（失败）治疗包括：标准三联疗法（n = 179）、序贯疗法（n = 27）和伴同疗法（n = 44）；97%的患者服用了所有药物，4例失访。意向性治疗和符合方案分析的根除率分别为82.4%（95%CI，77 - 87%）和85.7%（95%CI，81 - 90%）。治愈率与诊断（溃疡，77%；消化不良，82%）和既往治疗（标准三联疗法，83%；序贯疗法，89%；伴同疗法，77%）无关。多因素分析显示，仅年龄与根除相关（OR = 0.957；95%CI，0.933 - 0.981）。25.2%的患者报告了不良事件：腹泻（9.6%）、腹痛（9.6%）和恶心（9.2%）。