Ciccaglione Antonio Francesco, Tavani Roberta, Grossi Laurino, Cellini Luigina, Manzoli Lamberto, Marzio Leonardo
Digestive Sciences Unit, Pescara Civic Hospital, G. d'Annunzio University, Pescara, Italy.
Departments of Drug Sciences, G. d'Annunzio University, Chieti, Italy.
Helicobacter. 2016 Oct;21(5):375-81. doi: 10.1111/hel.12296. Epub 2016 Jan 25.
To evaluate the therapeutic gain of the addition of bismuth to a rifabutin containing triple therapy with amoxicillin and pantoprazole at standard dosages for the treatment of third-line Helicobacter pylori infection after a preliminary susceptibility test.
Two separate groups of patients in two pilot studies which were carried out simultaneously. One group was treated with rifabutin 150 mg b.i.d., pantoprazole 20 mg b.i.d., and amoxicillin 1 g b.i.d. for 10 days and the other group with rifabutin 150 mg b.i.d., pantoprazole 20 mg b.i.d., amoxicillin 1 g b.i.d., and bismuth subcitrate 240 mg b.i.d. for 10 days. All patients underwent to culture and susceptibility testing prior to their inclusion in the study. A successful outcome was confirmed with an Urea Breath test performed 8 weeks after the end of treatment. A blood cell count was performed for all patients at the start and after 5 days of treatment since rifabutin has been shown to inhibit the growth of leucocytes.
Twenty-nine patients were recruited in the pantoprazole, amoxicillin, rifabutin group and 30 in the pantoprazole, amoxicillin, rifabutin, and bismuth subcitrate group. All patients had a positive H. pylori culture and the susceptibility test used showed H. pylori sensitivity to rifabutin and amoxicillin. H. pylori eradication during follow-up was 18/27 (66.7%, 95% CI: 47.7-85.7%) in the pantoprazole, amoxicillin, rifabutin group and 28/29 (96.6%, 95% CI: 89.5-100.0%) in the pantoprazole, amoxicillin, rifabutin, and bismuth subcitrate group. Both treatments were well-tolerated with no reported side effects. Blood cell count remained normal in all patients.
The addition of bismuth subcitrate to a triple therapy that includes proton pump inhibitors, amoxicillin, and rifabutin in patients who are treated for the third time for H. pylori infection resulted in a 30% therapeutic gain.
在初步药敏试验后，评估在含利福布汀的三联疗法（标准剂量的阿莫西林和泮托拉唑）中添加铋剂对治疗三线幽门螺杆菌感染的治疗效果。
在两项同时进行的试点研究中，将患者分为两组。一组患者接受利福布汀150毫克，每日两次；泮托拉唑20毫克，每日两次；阿莫西林1克，每日两次，治疗10天；另一组患者接受利福布汀150毫克，每日两次；泮托拉唑20毫克，每日两次；阿莫西林1克，每日两次；枸橼酸铋240毫克，每日两次，治疗10天。所有患者在纳入研究前均进行了培养和药敏试验。治疗结束8周后进行尿素呼气试验，确认治疗成功。由于利福布汀已被证明可抑制白细胞生长，因此在治疗开始时和治疗5天后对所有患者进行血细胞计数。
泮托拉唑、阿莫西林、利福布汀组招募了29名患者，泮托拉唑、阿莫西林、利福布汀、枸橼酸铋组招募了30名患者。所有患者的幽门螺杆菌培养均为阳性，所用药敏试验显示幽门螺杆菌对利福布汀和阿莫西林敏感。泮托拉唑、阿莫西林、利福布汀组随访期间幽门螺杆菌根除率为18/27（66.7%，95%可信区间：47.7 - 85.7%），泮托拉唑、阿莫西林、利福布汀、枸橼酸铋组为28/29（96.6%，95%可信区间：89.5 - 100.0%）。两种治疗方法耐受性良好，均未报告副作用。所有患者的血细胞计数均保持正常。
在第三次治疗幽门螺杆菌感染的患者中，在包含质子泵抑制剂、阿莫西林和利福布汀的三联疗法中添加枸橼酸铋可使治疗效果提高30%。
