Lee Chang-Min, Kim Seong-Je, Choi Jung-Woo, Cho Hyun-Chin, Lee Ok-Jae
Department of Internal Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea.
Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea.
J Clin Med. 2024 Dec 16;13(24):7658. doi: 10.3390/jcm13247658.
Bismuth quadruple therapy (BQT) is recommended as the best second-line regimen after failure of first-line clarithromycin triple therapy (CTT) for eradication. However, there are some limitations to this approach, including the lack of an appropriate sequel regimen after failure of BQT and complicated administration. Metronidazole triple therapy (MTT) is simple to administer, but it is not widely recommended. This study was conducted to determine the efficacy of MTT as second-line regimen for eradication after failure of CTT. : We retrospectively reviewed the medical records of the Korean patients with infection who underwent second-line treatment after failure of first-line CTT from October 2013 to October 2019. The efficacy of MTT and BQT for eradication was compared. : The eradication rate in the BQT group tended to be higher than that in the MTT group; however, the difference was not statistically significant (208/233, 89.3% versus 244/284, 85.9%, = 0.287). Among 40 patients with second-line MTT eradication failure, 21 received the third-line BQT, and 15 showed successful eradication (15/21, 71.4%). In the men 70 years or older, the eradication rate of MTT was lower than that of BQT without statistical significance (75.8% versus 94.1%, = 0.141). : These findings suggested that MTT could be a second-line treatment option, reserving BQT for eradication after first line CTT failure, except in elderly men 70 years or older.
铋剂四联疗法（BQT）被推荐为一线克拉霉素三联疗法（CTT）根除失败后的最佳二线治疗方案。然而，这种方法存在一些局限性，包括BQT失败后缺乏合适的后续治疗方案以及给药复杂。甲硝唑三联疗法（MTT）给药简单，但未被广泛推荐。本研究旨在确定MTT作为CTT失败后二线根除治疗方案的疗效。我们回顾性分析了2013年10月至2019年10月期间在一线CTT失败后接受二线治疗的韩国感染患者的病历。比较了MTT和BQT的根除疗效。BQT组的根除率倾向于高于MTT组；然而，差异无统计学意义（208/233，89.3%对244/284，85.9%，=0.287）。在40例二线MTT根除失败的患者中，21例接受了三线BQT治疗，15例根除成功（15/21，71.4%）。在70岁及以上男性中，MTT的根除率低于BQT，但无统计学意义（75.8%对94.1%，=0.141）。这些结果表明，MTT可以作为二线治疗选择，一线CTT失败后保留BQT用于根除治疗，但70岁及以上老年男性除外。
