Katelaris Peter H, Katelaris Anthea L
Gastroenterology Department, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia.
London School of Hygiene and Tropical Medicine, London, UK.
Intern Med J. 2017 Jul;47(7):761-766. doi: 10.1111/imj.13432.
First-line Helicobacter pylori eradication failure is a common and challenging problem.
To assess the efficacy of salvage levofloxacin-based triple therapy in Australia.
Prospective patients referred after prior treatment failure(s) were prescribed esomeprazole 40 mg, amoxicillin 1 g and levofloxacin 500 mg each twice daily for 10 days. All patients received detailed written and verbal adherence support. Outcome assessment was by C-urea breath test and/or histology and urease test.
In 150 consecutive, evaluable patients (66% female, mean age 54 ± 14 years; six smokers), the main indications for treatment were peptic ulcer disease (17%), increased gastric cancer risk (20%), symptoms (35%) and other risk reduction (28%). The median number of previous treatments was 2 (range 1-7). Eradication of H. pylori was achieved in 90% (intention to treat (ITT)) and 91% (per-protocol (PP)) of patients. The eradication rate did not differ according to the type or number of prior treatments: 93% when ≤2 (n = 107) compared with 84% after three or more prior treatments (n = 43; P = 0.13) or with age, ethnicity or indication for treatment but it was higher in females (ITT 94 vs 82%, P = 0.04). Adherence was excellent (95%). No serious adverse effects were observed; mild adverse effects were reported in 11%. No primary levofloxacin resistance was observed in 20 concurrent cases.
The efficacy and safety of this levofloxacin-based triple therapy suggests it should be used as a salvage regimen in this region. Randomised comparative trials are unlikely to be done but these data compare favourably with local data for other salvage therapies.
一线根除幽门螺杆菌失败是一个常见且具有挑战性的问题。
评估在澳大利亚采用含左氧氟沙星的挽救三联疗法的疗效。
对先前治疗失败后转诊的前瞻性患者，给予埃索美拉唑40毫克、阿莫西林1克和左氧氟沙星500毫克，均每日两次，共10天。所有患者均获得详细的书面和口头依从性支持。通过碳-尿素呼气试验和/或组织学及尿素酶试验进行结果评估。
在150例连续可评估患者中（66%为女性，平均年龄54±14岁；6例吸烟者），治疗的主要指征为消化性溃疡病（17%）、胃癌风险增加（20%）、症状（35%）和其他风险降低（28%）。既往治疗的中位数为2次（范围1 - 7次）。90%（意向性治疗（ITT））和91%（符合方案（PP））的患者实现了幽门螺杆菌根除。根除率不因既往治疗的类型或次数而有所不同：≤2次既往治疗时为93%（n = 107），三次或更多次既往治疗后为84%（n = 43；P = 0.13），也不因年龄、种族或治疗指征而不同，但女性的根除率更高（ITT 94%对82%，P = 0.04）。依从性良好（95%）。未观察到严重不良反应；11%的患者报告有轻微不良反应。20例同期病例中未观察到原发性左氧氟沙星耐药。
这种含左氧氟沙星的三联疗法的疗效和安全性表明，它应作为该地区的挽救方案使用。不太可能进行随机对照试验，但这些数据与其他挽救疗法的当地数据相比具有优势。
