Costigan Conor, O'Sullivan Aoife M, O'Connell Jim, Sengupta Shreyashee, Butler Thomas, Molloy Stephen, O'Hara Fintan John, Ryan Barbara, Breslin Niall, O'Donnell Sarah, O'Connor Anthony, Smith Sinead, McNamara Deirdre
Trinity Academic Gastroenterology Group, School of Medicine-Trinity College Dublin, Dublin D2, Ireland.
Department of Gastroenterology, Tallaght University Hospital, Dublin D24 NR0A, Ireland.
World J Clin Cases. 2024 Jun 6;12(16):2773-2779. doi: 10.12998/wjcc.v12.i16.2773.
() eradication rates have fallen globally, likely in large part due to increasing antibiotic resistance to traditional therapy. In areas of high clarithromycin and metronidazole resistance such as ours, Maastricht VI guidelines suggest high dose amoxicillin dual therapy (HDADT) can be considered, subject to evidence for local efficacy. In this study we assess efficacy of HDADT therapy for eradication in an Irish cohort.
To assess the efficacy of HDADT therapy for eradication in an Irish cohort as both first line, and subsequent therapy for patients diagnosed with .
All patients testing positive for in a tertiary centre were treated prospectively with HDADT (amoxicillin 1 g and esomeprazole 40 mg × 14 d) over a period of 8 months. Eradication was confirmed with Urea Breath Test at least 4 wk after cessation of therapy. A delta-over-baseline > 4% was considered positive. Patient demographics and treatment outcomes were recorded, analysed and controlled for basic demographics and prior treatment.
One hundred and ninety-eight patients were identified with infection, 10 patients were excluded due to penicillin allergy and 38 patients refused follow up testing. In all 139 were included in the analysis, 55% ( = 76) were female, mean age was 46.6 years. Overall, 93 (67%) of patients were treatment-naïve and 46 (33%) had received at least one previous course of treatment. The groups were statistically similar. Self-reported compliance with HDADT was 97%, mild side-effects occurred in 7%. There were no serious adverse drug reactions. Overall the eradication rate for our cohort was 56% (78/139). Eradication rates were worse for those with previous treatment [43% (20/46) 62% (58/93), = 0.0458, odds ratio = 2.15]. Age and Gender had no effect on eradication status.
Overall eradication rates with HDADT were disappointing. Despite being a simple and possibly better tolerated regime, these results do not support its routine use in a high dual resistance country. Further investigation of other regimens to achieve the > 90% eradication target is needed.
全球范围内（幽门螺杆菌）根除率有所下降，这可能在很大程度上归因于对传统疗法的抗生素耐药性增加。在我们所在的克拉霉素和甲硝唑高耐药地区，马斯特里赫特VI指南建议，在有局部疗效证据的情况下，可考虑采用高剂量阿莫西林双联疗法（HDADT）。在本研究中，我们评估了HDADT疗法在爱尔兰队列中根除（幽门螺杆菌）的疗效。
评估HDADT疗法作为一线治疗以及对诊断为（幽门螺杆菌感染）的患者后续治疗时在爱尔兰队列中根除（幽门螺杆菌）的疗效。
在一家三级中心所有检测出（幽门螺杆菌）呈阳性的患者在8个月的时间里前瞻性地接受HDADT治疗（阿莫西林1克和埃索美拉唑40毫克，每日两次，共14天）。在治疗结束至少4周后通过尿素呼气试验确认根除情况。基线差值>4%被视为阳性。记录患者的人口统计学信息和治疗结果，并针对基本人口统计学信息和既往（幽门螺杆菌）治疗情况进行分析和对照。
共识别出198例（幽门螺杆菌）感染患者，10例因青霉素过敏被排除，38例拒绝接受随访检测。总计139例纳入分析，其中55%（n = 76）为女性，平均年龄为46.6岁。总体而言，93例（67%）患者为初治患者，46例（33%）曾接受过至少一个疗程的治疗。两组在统计学上相似。自我报告的HDADT依从率为97%，7%出现轻度副作用。未发生严重药物不良反应。总体而言，我们队列的根除率为56%（78/139）。既往接受过治疗的患者根除率较低[43%（20/46）对比62%（58/93），P = 0.0458，比值比 = 2.15]。年龄和性别对根除情况无影响。
HDADT的总体根除率令人失望。尽管该疗法简单且耐受性可能更好，但这些结果不支持在高双重耐药国家将其作为常规治疗方法。需要进一步研究其他疗法以实现>90%的根除目标。
