Hung Kuo-Tung, Yang Shih-Cheng, Wu Cheng-Kun, Wang Hsing-Ming, Yao Chih-Chien, Liang Chih-Ming, Tai Wei-Chen, Wu Keng-Liang, Kuo Yuan-Hung, Lee Chen-Hsiang, Chuah Seng-Kee
Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Chang Gung University, College of Medicine, Taoyuan, Taiwan.
Infect Drug Resist. 2021 Mar 25;14:1239-1246. doi: 10.2147/IDR.S304711. eCollection 2021.
Non-bismuth concomitant quadruple therapy is commonly administered in Taiwan, achieving an acceptable efficacy as a first-line anti treatment. This study compared the eradication rates between esomeprazole- and lansoprazole-based non-bismuth concomitant quadruple therapy for first-line anti- treatment.
This study included 206 -infected naïve patients between July 2016 and February 2019. The patients were prescribed with either a 7-day non-bismuth containing quadruple therapy (esomeprazole, 40 mg twice daily; amoxicillin, 1 g twice daily; and metronidazole, 500 mg twice daily; and clarithromycin, 500 mg twice daily for 7 days [EACM group]; lansoprazole, 30 mg twice daily; amoxicillin, 1 g twice daily; metronidazole, 500 mg twice daily; and clarithromycin, 500 mg twice daily [LACM group]). Then, the patients were asked to perform urea breath tests 8 weeks later.
The eradication rates in the EACM group were 86.1% (95% confidence interval [CI], 77.8%-92.2%) and 90.6% (95% CI, 82.9%-95.6%) in the intention-to-treat (ITT) and the per-protocol (PP) analyses, respectively. Moreover, the eradication rates in the LACM group were 90.1% (95% CI, 82.6%-95.2%) and 92.6% (95% CI, 85.5%-96.9%) in the ITT and the PP analyses, respectively. Consequently, the LACM group exhibited more diarrhea patients than the EACM group (7.1% versus 1.0%, = 0.029), but all symptoms were mild. Univariate analysis in this study showed that metronidazole-resistant strains were the clinical factor affecting the eradications (95.3% versus 78.9%, = 0.044). Moreover, a trend was observed in dual clarithromycin- and metronidazole-resistant strains (91.5% versus 66.7%, = 0.155).
The eradication rates between esomeprazole and lansoprazole-based non-bismuth concomitant quadruple therapy for first-line treatment were similar in this study. Both could achieve a > 90% report card in the PP analysis.
非铋剂联合四联疗法在台湾地区普遍应用，作为一线抗幽门螺杆菌治疗取得了可接受的疗效。本研究比较了基于埃索美拉唑和兰索拉唑的非铋剂联合四联疗法用于一线抗幽门螺杆菌治疗的根除率。
本研究纳入了2016年7月至2019年2月期间206例初治幽门螺杆菌感染患者。患者被给予为期7天的不含铋剂四联疗法（埃索美拉唑，40毫克每日两次；阿莫西林，1克每日两次；甲硝唑，500毫克每日两次；克拉霉素，500毫克每日两次，共7天[EACM组]；兰索拉唑，30毫克每日两次；阿莫西林，1克每日两次；甲硝唑，500毫克每日两次；克拉霉素，500毫克每日两次[LACM组]）。然后，要求患者在8周后进行尿素呼气试验。
EACM组在意向性分析（ITT）和符合方案分析（PP）中的根除率分别为86.1%（95%置信区间[CI]，77.8%-92.2%）和90.6%（95%CI，82.9%-95.6%）。此外，LACM组在ITT和PP分析中的根除率分别为90.1%（95%CI，82.6%-95.2%）和92.6%（95%CI，85.5%-96.9%）。因此，LACM组腹泻患者比EACM组多（7.1%对1.0%，P = 0.029），但所有症状均较轻。本研究的单因素分析表明，甲硝唑耐药菌株是影响根除的临床因素（95.3%对78.9%，P = 0.044）。此外，在克拉霉素和甲硝唑双重耐药菌株中观察到一种趋势（91.5%对66.7%，P = 0.155）。
本研究中，基于埃索美拉唑和兰索拉唑的非铋剂联合四联疗法用于一线幽门螺杆菌治疗的根除率相似。在PP分析中两者均可取得>90%的成绩单。
