Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
Helicobacter. 2021 Feb;26(1):e12759. doi: 10.1111/hel.12759. Epub 2020 Oct 28.
Bismuth-containing quadruple therapy is an effective alternative first-line therapy for Helicobacter pylori infection. We evaluated the efficacy and safety of a modified twice-a-day bismuth quadruple regimen (BQT-2) with low-dose (1000 mg total) metronidazole as first-line therapy for the eradication of H pylori.
In this prospective pilot study, patients diagnosed with H pylori infection and naïve to eradication therapy were included. The modified BQT-2 therapy consisted of rabeprazole 20 mg, amoxicillin 1 g, metronidazole 500 mg, and tripotassium dicitrato bismuthate 600 mg (elemental bismuth 240 mg) twice daily, given 30 minutes before morning and evening meals for 14 days. H pylori eradication was assessed by C-urea breath test conducted at least 4 weeks after therapy completion.
In 66 patients who received the modified BQT-2 regimen, the compliance rate was 100% and the H pylori eradication rate was 77.3%. H pylori was successfully cultured in 50 (75.8%) patients. The resistance rates to metronidazole and clarithromycin were 30.0% and 22.0%, respectively. Eradication rates were not significantly different according to the resistance to metronidazole (metronidazole-susceptible: 74.3% [26/35], metronidazole-resistant: 73.3% [11/15]; P > .99). Most of the adverse events were mild, with 20 (30%) patients developing nausea, epigastric soreness, loose stool, asthenia, skin rash, dizziness, taste perversion, headache, or dyspepsia.
Twice-a-day modified BQT-2 regimen with low-dose metronidazole was suboptimal as an alternative first-line therapy for eradicating H pylori, despite high patient compliance.
含铋四联疗法是治疗幽门螺杆菌感染的有效一线替代疗法。我们评估了低剂量（总剂量 1000mg）甲硝唑的改良每日两次铋四联方案（BQT-2）作为一线治疗方案根除幽门螺杆菌的疗效和安全性。
在这项前瞻性试点研究中，纳入了诊断为幽门螺杆菌感染且对根除治疗无经验的患者。改良 BQT-2 治疗方案包括雷贝拉唑 20mg、阿莫西林 1g、甲硝唑 500mg 和柠檬酸三钾二铋 600mg（元素铋 240mg），每日两次，于早晚餐前 30 分钟服用，共 14 天。治疗结束至少 4 周后，通过 C-尿素呼气试验评估幽门螺杆菌根除情况。
在接受改良 BQT-2 方案治疗的 66 例患者中，依从率为 100%，幽门螺杆菌根除率为 77.3%。50 例（75.8%）患者成功培养出幽门螺杆菌。甲硝唑和克拉霉素的耐药率分别为 30.0%和 22.0%。甲硝唑耐药患者（甲硝唑敏感：74.3%[26/35]；甲硝唑耐药：73.3%[11/15]）与甲硝唑敏感患者的根除率无显著差异（P>.99）。大多数不良反应轻微，20 例（30%）患者出现恶心、上腹痛、稀便、乏力、皮疹、头晕、味觉异常、头痛或消化不良。
尽管患者依从性高，但低剂量甲硝唑的改良每日两次 BQT-2 方案作为根除幽门螺杆菌的替代一线治疗方案效果不佳。
