Branquinho Diogo, Almeida Nuno, Gregório Carlos, Cabral José Eduardo Pina, Casela Adriano, Donato Maria Manuel, Tomé Luís
Gastroenterology Department, Coimbra University Hospital, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.
Gastroenterology Centre, Faculty of Medicine, Coimbra University, R. Larga, 3004-504, Coimbra, Portugal.
BMC Gastroenterol. 2017 Feb 15;17(1):31. doi: 10.1186/s12876-017-0589-6.
Helicobacter pylori eradication rates in Portugal are declining, due to increased resistance of this bacterium to antimicrobial agents, especially Clarithromycin. Quadruple Levofloxacin-containing regimens could be an option for first-line treatment, but its efficacy should be evaluated as fluoroquinolone resistance is rapidly increasing. Our aim was to compare the efficacy of Clarithromycin and Levofloxacin-based sequential quadruple therapies as first-line treatment options and determine factors associated with treatment failure.
A total of 200 Helicobacter pylori infected patients were retrospectively included (female 57.5%; average age: 53.2 ± 15.7) and received either 10-day sequential therapy (Proton-Pump Inhibitor + Amoxicillin 1 g bid for 5 days and Proton-Pump Inhibitor + Clarithromycin 500 mg + Metronidazole/Tinidazole 500 mg bid/tid in the following 5 days; group A) or a 10-day modified sequential therapy with Levofloxacin 500 mg id instead of Clarithromycin (group B). Eradication was confirmed with urea breath test. Variables that could influence success rate were analyzed.
There were no differences between groups in terms of gender, age, smoking habits and indications for treatment. The eradication rate obtained with Clarithromycin-based sequential treatment was significantly higher than with Levofloxacin-based therapy (90%, CI95%: 84-96% vs. 79%, CI95%: 71-87%, p = 0.001). Using full-dose proton-pump inhibitor and high-dose Metronidazole in group A, and full-dose proton-pump inhibitor and prescription from a Gastroenterologist in group B were associated with eradication success.
Ten-day Levofloxacin-based sequential treatment achieved inadequate efficacy rate (<80%) and should not be adopted as first-line therapy. Standard sequential therapy showed significantly better results in this naïve population. Using full-dose proton-pump inhibitor and higher doses of Metronidazole is essential to achieve such results.
由于幽门螺杆菌对抗菌药物尤其是克拉霉素的耐药性增加，葡萄牙的幽门螺杆菌根除率正在下降。含左氧氟沙星的四联疗法可能是一线治疗的一种选择，但随着氟喹诺酮耐药性迅速增加，其疗效应进行评估。我们的目的是比较基于克拉霉素和左氧氟沙星的序贯四联疗法作为一线治疗方案的疗效，并确定与治疗失败相关的因素。
回顾性纳入200例幽门螺杆菌感染患者（女性占57.5%；平均年龄：53.2±15.7岁），他们接受了10天的序贯疗法（质子泵抑制剂+阿莫西林1g，每日两次，共5天，随后5天为质子泵抑制剂+克拉霉素500mg+甲硝唑/替硝唑500mg，每日两次/三次；A组）或用500mg左氧氟沙星每日一次替代克拉霉素的10天改良序贯疗法（B组）。通过尿素呼气试验确认根除情况。分析可能影响成功率的变量。
两组在性别、年龄、吸烟习惯和治疗指征方面无差异。基于克拉霉素的序贯治疗获得的根除率显著高于基于左氧氟沙星的治疗（90%，95%置信区间：84 - 96% 对比 79%，95%置信区间：71 - 87%，p = 0.001）。A组使用全剂量质子泵抑制剂和高剂量甲硝唑，B组使用全剂量质子泵抑制剂以及由胃肠病学家开处方与根除成功相关。
基于左氧氟沙星的10天序贯治疗疗效不足（<80%），不应作为一线治疗方法采用。在这个初治人群中，标准序贯疗法显示出明显更好的结果。使用全剂量质子泵抑制剂和更高剂量的甲硝唑对于取得这样的结果至关重要。
