Dolapcioglu Can, Sayiner Mehmet, Akkus Esra Elif, Kural Abdulaziz, Dolapcioglu Hatice, Dabak Resat, Ahishali Emel
Department of Gastroenterology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Istanbul, Turkey.
Department of Family Medicine, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Istanbul, Turkey.
Helicobacter. 2016 Apr;21(2):100-5. doi: 10.1111/hel.12241. Epub 2015 Jun 23.
Widespread use of antibiotics has resulted in increased rates of antibiotic resistance and decreased rates of Helicobacter pylori (H. pylori) eradication, leading to a search for newer therapeutic options. This study aimed to examine the efficacy, tolerability, and patient compliance of a first-line bismuth-containing 5-day concomitant quintuple therapy.
This prospective study included 144 eradication treatment naïve H. pylori positive patients with dyspeptic complaints. Patients received the following concomitant quintuple therapy for 5 days: bismuth subcitrate 300 mg q.i.d, omeprazole 20 mg b.i.d, clarithromycin 500 mg b.i.d., amoxicillin 1 g b.i.d., and metronidazole 500 mg t.i.d. Eradication was assessed with H. pylori stool antigen test or urea-breath test 6 weeks after the completion of therapy.
Treatment compliance rate in this study was 97.2%. Intention to treat and per-protocol eradication rates were 134/144 (93.1%, 95% CI, 88.9-97.2) and 134/140 (95.7%, 95% CI, 92.2-98.6), respectively. Side effect was reported by 8.5% of the patients that attended follow-up visits, including epigastric pain (2.8%), nausea/vomiting (2.1%), diarrhea (1.4%), taste disturbance (1.4%), and fatigue (0.7%).
Bismuth-containing, short course, quintuple concomitant therapy appears to be an effective and safe therapeutic option for the first-line H. pylori eradication, particularly in populations with high resistance.
抗生素的广泛使用导致抗生素耐药率上升，幽门螺杆菌（H. pylori）根除率下降，从而促使人们寻找更新的治疗方案。本研究旨在探讨一线含铋剂的5天联合五联疗法的疗效、耐受性和患者依从性。
这项前瞻性研究纳入了144例初治的有消化不良症状的H. pylori阳性患者。患者接受以下联合五联疗法治疗5天：枸橼酸铋钾300毫克，每日4次；奥美拉唑20毫克，每日2次；克拉霉素500毫克，每日2次；阿莫西林1克，每日2次；甲硝唑500毫克，每日3次。治疗结束6周后，通过H. pylori粪便抗原检测或尿素呼气试验评估根除情况。
本研究的治疗依从率为97.2%。意向性治疗和符合方案分析的根除率分别为134/144（93.1%，95%可信区间，88.9-97.2）和134/140（95.7%，95%可信区间，92.2-98.6）。8.5%接受随访的患者报告有副作用，包括上腹部疼痛（2.8%）、恶心/呕吐（2.1%）、腹泻（1.4%）、味觉障碍（1.4%）和疲劳（0.7%）。
含铋剂的短疗程五联联合疗法似乎是一线根除H. pylori的有效且安全的治疗选择，尤其是在耐药率高的人群中。
