Aparato Digestivo, Complejo Hospitalario de Toledo, España.
Aparato Digestivo, Complejo Hospitalario de Toledo.
Rev Esp Enferm Dig. 2019 Sep;111(9):655-661. doi: 10.17235/reed.2019.6198/2019.
the previous intake of macrolide antibiotics is associated with a failure to eradicate Helicobacter pylori (H. pylori) with clarithromycin-containing regimens. However, the standard triple therapy achieves eradication rates of over 90% in patients without a previous use of macrolides in our health area. The aim of this study was to evaluate the efficacy of an H. pylori eradication strategy based on the intake of macrolides by the patient during the previous years.
one hundred and sixty-nine patients with H. pylori infection were prospectively included in the study. The electronic medical record of each patient was reviewed at the time of inclusion. Depending on their previous intake of macrolides, patients were assigned to one of two eradication regimens: group A) patients without a previous intake of macrolides received an optimized triple therapy for 14 days; and group B) patients with a previous intake of macrolides received bismuth quadruple therapy for ten days.
ninety-one patients (53.84%) without a previous intake of macrolides received an optimized triple therapy (group A) and 78 patients (46.15%) with a previous intake of macrolides received bismuth quadruple therapy (group B). In group A, the H. pylori eradication rates were 90.11% in the intention-to-treat and 95.35% in the per-protocol analysis. In group B, the H. pylori eradication rates were 85.89% in the intention-to-treat and 98.5% in the per-protocol analysis. The overall eradication rates obtained using this strategy were 88.16% (95% CI: 82.32-92.02%) in the intention-to-treat and 96.75% (95% CI: 92.59-98.94%) in the per-protocol analysis.
an H. pylori eradication strategy based on the intake of macrolides during the previous years achieves overall eradication rates close to 90% and allows the use of standard triple therapy in more than half of the patients from a health area with a high level of clarithromycin resistance.
先前摄入大环内酯类抗生素与克拉霉素含药方案未能根除幽门螺杆菌（H. pylori）有关。然而，在我们的卫生区域，标准三联疗法在没有先前使用大环内酯类药物的患者中实现了超过 90%的根除率。本研究旨在评估基于患者前几年摄入大环内酯类药物的 H. pylori 根除策略的疗效。
169 例 H. pylori 感染患者前瞻性纳入研究。在纳入时，每位患者的电子病历均进行了回顾。根据他们之前摄入大环内酯类药物的情况，将患者分为两种根除方案之一：A 组）未摄入大环内酯类药物的患者接受为期 14 天的优化三联疗法；B 组）摄入过大环内酯类药物的患者接受为期 10 天的铋四联疗法。
91 例（53.84%）未摄入大环内酯类药物的患者接受了优化三联疗法（A 组），78 例（46.15%）摄入过大环内酯类药物的患者接受了铋四联疗法（B 组）。在 A 组中，意向治疗的 H. pylori 根除率为 90.11%，按方案分析的根除率为 95.35%。在 B 组中，意向治疗的 H. pylori 根除率为 85.89%，按方案分析的根除率为 98.5%。采用该策略的总体根除率在意向治疗中为 88.16%（95%CI：82.32-92.02%），在按方案分析中为 96.75%（95%CI：92.59-98.94%）。
基于前几年摄入大环内酯类药物的 H. pylori 根除策略可实现接近 90%的总体根除率，并允许在大环内酯类药物耐药率较高的卫生区域的一半以上患者中使用标准三联疗法。
