Katelaris P H, Patchett S E, Zhang Z W, Domizio P, Farthing M J
Department of Gastroenterology, St Bartholomew's Hospital, London, UK.
Aliment Pharmacol Ther. 1995 Apr;9(2):205-8. doi: 10.1111/j.1365-2036.1995.tb00373.x.
To compare H. pylori eradication rates using omeprazole in conjunction with either amoxycillin or clarithromycin.
Omeprazole with amoxycillin is the most widely used dual therapy regimen for eradication of H. pylori. A recent open study suggested a high eradication rate combining omeprazole with the newer macrolide, clarithromycin.
A randomized prospective trial in 54 patients was conducted to compare 2 weeks of treatment with omeprazole 40 mg once daily and either amoxycillin 500 mg three times daily or clarithromycin 500 mg three times daily. H. pylori eradication was assessed using the 13C urea breath test.
Eradication was achieved in 18/26 (69.2%) of subjects treated with omeprazole and amoxycillin and 18/25 (72.0%) of those treated with omeprazole and clarithromycin (P = N.S.). Minor side effects, most commonly altered taste, were reported by 16% of patients and were more frequent in those randomized to clarithromycin (P = 0.01).
These regimens are similarly effective. However, clarithromycin is more expensive, associated with a greater frequency of side effects and, unlike amoxycillin, resistance by H. pylori has been reported. This suggests that clarithromycin may be a useful alternative when there is penicillin allergy or previous treatment failure, but it should not replace amoxycillin as first choice in omeprazole-based dual therapy.
比较奥美拉唑联合阿莫西林或克拉霉素治疗幽门螺杆菌的根除率。
奥美拉唑与阿莫西林联合使用是根除幽门螺杆菌最广泛应用的双联疗法方案。最近一项开放性研究表明，奥美拉唑与新型大环内酯类药物克拉霉素联合使用时根除率较高。
对54例患者进行了一项随机前瞻性试验，比较每天一次服用40mg奥美拉唑，同时每天三次服用500mg阿莫西林或每天三次服用500mg克拉霉素，持续治疗2周的效果。采用13C尿素呼气试验评估幽门螺杆菌的根除情况。
接受奥美拉唑和阿莫西林治疗的患者中，18/26（69.2%）实现了根除；接受奥美拉唑和克拉霉素治疗的患者中，18/25（72.0%）实现了根除（P = 无显著差异）。16%的患者报告有轻微副作用，最常见的是味觉改变，在随机分配接受克拉霉素治疗的患者中更常见（P = 0.01）。
这些方案同样有效。然而，克拉霉素更昂贵，副作用发生率更高，而且与阿莫西林不同，已有幽门螺杆菌对其产生耐药性的报道。这表明，当患者对青霉素过敏或既往治疗失败时，克拉霉素可能是一种有用的替代药物，但在基于奥美拉唑的双联疗法中，它不应取代阿莫西林作为首选药物。
