Adachi Teppei, Matsui Shigenaga, Watanabe Tomohiro, Okamoto Kazuki, Okamoto Ayana, Kono Masashi, Yamada Mitsunari, Nagai Tomoyuki, Komeda Yoriaki, Minaga Kosuke, Kamata Ken, Yamao Kentaro, Takenaka Mamoru, Asakuma Yutaka, Sakurai Toshiharu, Nishida Naoshi, Kashida Hiroshi, Kudo Masatoshi
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Oncology. 2017;93 Suppl 1:15-19. doi: 10.1159/000481224. Epub 2017 Dec 20.
Clarithromycin (CAM)-based triple therapy comprising proton pump inhibitors and amoxicillin is administered as first-line eradication treatment against Helicobacter pylori infection. However, the eradication rate achieved with CAM-based triple therapy has decreased to <80% owing to the emergence of CAM-resistant strains. This prospective randomized study aimed to compare the efficacy of CAM-based and metronidazole (MNZ)-based triple therapy in terms of H. pylori eradication.
H. pylori-positive patients were treated with CAM-based triple therapy comprising esomeprazole and amoxicillin (EAC group) or with MNZ-based triple therapy comprising esomeprazole and amoxicillin (EAM group).
H. pylori eradication rates achieved in the intention-to-treat (ITT) and per protocol (PP) analyses were 70.6 and 72.7%, respectively, in the EAC group. Eradication rates obtained via ITT and PP analyses were 91.7 and 94.3%, respectively, in the EAM group. In the EAC group, eradication rates were significantly lower in patients harboring CAM-resistant strains than in those harboring CAM-sensitive strains. In contrast, eradication rates were comparable between patients harboring CAM-resistant strains and those harboring CAM-sensitive strains in the EAM group.
MNZ-based triple therapy consisting of esomeprazole and amoxicillin is superior to CAM-based triple therapy containing esomeprazole and amoxicillin as first-line eradication treatment against H. pylori.
包含质子泵抑制剂和阿莫西林的基于克拉霉素（CAM）的三联疗法被用作根除幽门螺杆菌感染的一线治疗方案。然而，由于对CAM耐药菌株的出现，基于CAM的三联疗法的根除率已降至<80%。这项前瞻性随机研究旨在比较基于CAM的三联疗法和基于甲硝唑（MNZ）的三联疗法在根除幽门螺杆菌方面的疗效。
幽门螺杆菌阳性患者接受包含埃索美拉唑和阿莫西林的基于CAM的三联疗法（EAC组）或接受包含埃索美拉唑和阿莫西林的基于MNZ的三联疗法（EAM组）。
EAC组在意向性治疗（ITT）分析和符合方案（PP）分析中实现的幽门螺杆菌根除率分别为70.6%和72.7%。EAM组通过ITT和PP分析获得的根除率分别为91.7%和94.3%。在EAC组中，携带CAM耐药菌株的患者的根除率显著低于携带CAM敏感菌株的患者。相比之下，EAM组中携带CAM耐药菌株的患者和携带CAM敏感菌株的患者之间的根除率相当。
由埃索美拉唑和阿莫西林组成的基于MNZ的三联疗法作为根除幽门螺杆菌的一线治疗方案优于包含埃索美拉唑和阿莫西林的基于CAM的三联疗法。
