Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, China.
BMC Gastroenterol. 2019 Jul 25;19(1):132. doi: 10.1186/s12876-019-1056-3.
Eradicating Helicobacter pylori infection is clinically challenging, notably in cases with penicillin allergy. Cephalosporin could be used in lieu of amoxicillin to eradicate Helicobacter pylori. The current work aimed to assess therapeutic efficacy and safety of a cefuroxime-based quadruple regimen in treatment-naïve individuals with penicillin allergy, as well as patient compliance.
In the present prospective single-center cohort study, 152 Helicobacter pylori infected individuals with penicillin allergy received eradication therapy with cefuroxime (500 mg twice/day), levofloxacin (500 mg once/day), esomeprazole (20 mg twice/day) and bismuth potassium citrate (220 mg twice/day; 14 days). Safety and compliance were evaluated 1 to 3 days upon eradication. The urea breath test was carried out 8 to 12 weeks upon eradication for efficacy assessment.
This quadruple antimicrobial regimen eradicated the pathogen at 85.5% (95% confidence interval (CI) 79.6-90.8%), 88.4% (95% CI 83.0-93.2%) and 90.1% (95% CI 85.2-94.4%) in intention-to-treat, modified intention-to-treat and per-protocol analyses, respectively, with resistance rates of 4.6 and 40.0% in the background of cefuroxime and levofloxacin, respectively. Meanwhile, 21.3% of patients had adverse reactions, but none was serious. A total of 95.3% of patients showed good compliance. Poor compliance and cefuroxime resistance were detected by uni- or multivariate analyses as independent factors predicting therapeutic failure. Eradication rates in patients with dual levofloxacin and cefuroxime susceptibility, isolated levofloxacin resistance, isolated cefuroxime resistance and dual resistance were 97.2, 84.0, 50.0, and 0%, respectively (P = 0.002).
Cefuroxime, levofloxacin, esomeprazole, and bismuth achieved decent efficacy, safety and compliance as first-line antimicrobial regimen in patients with Helicobacter pylori and penicillin allergy.
根除幽门螺杆菌感染具有临床挑战性，尤其是在青霉素过敏的情况下。头孢菌素可替代阿莫西林用于根除幽门螺杆菌。本研究旨在评估头孢呋辛为基础的四联方案在青霉素过敏的初治患者中的疗效和安全性，以及患者的依从性。
在这项前瞻性单中心队列研究中，152 例青霉素过敏的幽门螺杆菌感染患者接受了头孢呋辛（500mg，每日 2 次）、左氧氟沙星（500mg，每日 1 次）、埃索美拉唑（20mg，每日 2 次）和枸橼酸铋钾（220mg，每日 2 次；14 天）的根除治疗。在根除治疗后 1-3 天评估安全性和依从性。在根除治疗后 8-12 周进行尿素呼气试验以评估疗效。
该四联抗菌方案在意向治疗、改良意向治疗和方案分析中分别以 85.5%（95%置信区间（CI）79.6-90.8%）、88.4%（95%CI 83.0-93.2%）和 90.1%（95%CI 85.2-94.4%）根除了病原体，头孢呋辛和左氧氟沙星的耐药率分别为 4.6%和 40.0%。同时，21.3%的患者出现不良反应，但均不严重。总共有 95.3%的患者表现出良好的依从性。单因素或多因素分析显示，依从性差和头孢呋辛耐药是预测治疗失败的独立因素。对左氧氟沙星和头孢呋辛双重敏感、单独左氧氟沙星耐药、单独头孢呋辛耐药和双重耐药的患者，其根除率分别为 97.2%、84.0%、50.0%和 0%（P=0.002）。
头孢呋辛、左氧氟沙星、埃索美拉唑和枸橼酸铋钾作为青霉素过敏的幽门螺杆菌患者的一线抗菌方案，具有良好的疗效、安全性和依从性。
