Murata Masaki, Sugimoto Mitsushige, Mizuno Hitomi, Kanno Takeshi, Satoh Kiichi
Department of Gastroenterology, Shiga University of Medical Science Hospital, Otsu, Shiga 520-2192, Japan.
Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Fushimi, Kyoto 612-8555, Japan.
J Clin Med. 2020 Feb 17;9(2):543. doi: 10.3390/jcm9020543.
International treatment guidelines for infection recommend a proton pump inhibitor (PPI)/amoxicillin/clarithromycin (CAM) regimen (PAC) or PPI/amoxicillin/metronidazole (MNZ) regimen (PAM) as first-line therapy based on culture and sensitivity testing. As incidence rates of antimicrobial agent-resistant strains are changing year by year, it is important to reevaluate the efficacy of eradication regimens. We performed a meta-analysis to evaluate the efficacy and safety of PAC and PAM based on different locations categorized by the reported incidence of CAM- and MNZ-resistant strains.
Randomized control trials (RCTs) comparing eradication rates between PAC and PAM first-line treatment up to December 2018 were included. We divided RCTs into four groups based on resistance to CAM (< 15% or ≥ 15%) and MNZ (< 15% or ≥ 15%).
A total of 27 studies (4825 patients) were included. Overall eradication rates between PAC and PAM were similar (74.8% and 72.5%, relative risk (RR): 1.13, 95% confidence interval (CI): 0.91-1.39, = 0.27) in the intention-to-treat analysis. In areas with low MNZ- and high CAM-resistance rates, PAM had a significantly higher eradication rate than PAC (92.5% vs. 70.8%, RR: 0.29, 95% CI: 0.13-0.68). In areas with high MNZ- and low CAM-resistance rates, the eradication rate with PAC was only 72.9%.
Overall eradication rates with PAC and PAM were equivalent worldwide. In low MNZ-resistance areas, PAM may be recommended as first-line therapy. However, the efficacy of PAC may be insufficient, irrespective of susceptibility to CAM.
感染的国际治疗指南推荐基于培养和药敏试验，将质子泵抑制剂（PPI）/阿莫西林/克拉霉素（CAM）方案（PAC）或PPI/阿莫西林/甲硝唑（MNZ）方案（PAM）作为一线治疗。由于抗菌药物耐药菌株的发生率逐年变化，重新评估根除方案的疗效很重要。我们进行了一项荟萃分析，以评估根据CAM和MNZ耐药菌株报告发生率分类的不同地区的PAC和PAM的疗效和安全性。
纳入截至2018年12月比较PAC和PAM一线治疗根除率的随机对照试验（RCT）。我们根据对CAM（<15%或≥15%）和MNZ（<15%或≥15%）的耐药性将RCT分为四组。
共纳入27项研究（4825例患者）。在意向性分析中，PAC和PAM的总体根除率相似（74.8%和72.5%，相对风险（RR）：1.13，95%置信区间（CI）：0.91-1.39，P = 0.27）。在MNZ耐药率低和CAM耐药率高的地区，PAM的根除率显著高于PAC（92.5%对70.8%，RR：0.29，95%CI：0.13-0.68）。在MNZ耐药率高和CAM耐药率低的地区，PAC的根除率仅为72.9%。
全球范围内PAC和PAM的总体根除率相当。在MNZ耐药率低的地区，可推荐PAM作为一线治疗。然而，无论对CAM的敏感性如何，PAC的疗效可能不足。
