Franceschi F, Ojetti V, Gabrielli M, Petruzziello C, Tortora A, Gasbarrini G, Lopetuso L R, Scaldaferri F, Gasbarrini A
Internal Medicine Institute and Internal Medicine and Gastroenterology; Catholic University of the Scred heart, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2016;20(2):297-300.
Helicobater (H.) pylori eradication rates with standard first-line triple therapy have declined to unacceptable levels. To date, amoxicillin-resistant H. pylori strains have rarely been detected. Whether increasing the dosage of amoxicillin in a standard 7 days eradicating regimen may enhance its efficacy is not known. The aim of this paper is to compare the efficacy of a 7 days high-dose amoxicillin based first-line regimen with sequential therapy.
We have retrospectively analyzed data from 300 sex and age matched patients, who underwent 3 different therapeutic schemes: (1) standard LCA, lansoprazole 30 mg bid, clarithromycin 500 mg bid and amoxicillin 1000 mg bid for 7 days; (2) high dose LCA (HD-LCA), lansoprazole 30 mg bid, clarithromycin 500 mg bid and amoxicillin 1000 mg tid for 7 days; (3) sequential LACT, lansoprazole 30 mg bid plus amoxicillin 1000 mg bid for 5 days, followed by lansoprazole 30 mg bid, clarithromycin 500 mg bid and tinidazole 500 mg bid for 5 days. Eradication was confirmed by 13C-urea breath test. Compliance and occurrence of adverse effects were also assessed.
Eradication rates were: 55% for LCA, 75% for HD-LCA and 73% for LACT. Eradication rates were higher in HD-LCA group compared to LCA (p<0.01), while no significant differences were observed in HD-LCA group compared to LACT (p=ns). Compliance and occurrence of adverse effects were similar among groups.
High-dose amoxicillin based eradicating treatment is superior to standard triple therapy and equivalent to sequential therapy; compared to the latter, the shorter duration may represent an advantage.
标准一线三联疗法的幽门螺杆菌（H. pylori）根除率已降至不可接受的水平。迄今为止，很少检测到对阿莫西林耐药的幽门螺杆菌菌株。在标准的7天根除方案中增加阿莫西林剂量是否能提高其疗效尚不清楚。本文旨在比较基于高剂量阿莫西林的7天一线方案与序贯疗法的疗效。
我们回顾性分析了300例性别和年龄匹配的患者的数据，这些患者接受了3种不同的治疗方案：（1）标准LCA，兰索拉唑30毫克，每日两次，克拉霉素500毫克，每日两次，阿莫西林1000毫克，每日两次，共7天；（2）高剂量LCA（HD-LCA），兰索拉唑30毫克，每日两次，克拉霉素500毫克，每日两次，阿莫西林1000毫克，每日三次，共7天；（3）序贯LACT，兰索拉唑30毫克，每日两次加阿莫西林1000毫克，每日两次，共5天，随后是兰索拉唑30毫克，每日两次，克拉霉素500毫克，每日两次和替硝唑500毫克，每日两次，共5天。通过13C-尿素呼气试验确认根除情况。还评估了依从性和不良反应的发生情况。
根除率分别为：LCA组55%，HD-LCA组75%，LACT组73%。HD-LCA组的根除率高于LCA组（p<0.01），而HD-LCA组与LACT组相比未观察到显著差异（p=无统计学意义）。各组之间的依从性和不良反应发生率相似。
基于高剂量阿莫西林的根除治疗优于标准三联疗法，且与序贯疗法相当；与后者相比，疗程较短可能是一个优势。
