Treiber G
Department of Gastroenterology, Robert-Bosch Hospital, Stuttgart, Federal Republic of Germany.
Am J Gastroenterol. 1996 Feb;91(2):246-57.
This review provides an updated overview on Helicobacter pylori (HP) trials, focusing on drug dosage and cost:benefit ratio.
Literature review, with analysis of 362 treatments with 13,562 patients.
Statistical evaluation demonstrated the following mean HP eradication rates (ER): 11.7% for monotherapy, 50.7% for dual therapy without acid suppression, 59.8% for dual therapy including acid suppression, 78.1% for triple therapy without acid suppression, 77.5% for triple therapy including acid suppression, and 89.1% for multiple combination therapy (differences between all groups, p < 0.001). In dual therapy, omeprazole/amoxicillin or clarithromycin (mean ER 65.9 vs. 67.6%, NS) showed better results than other combinations. Favorable results in triple therapy were achieved by combined bismuth/imidazoles/tetracycline or by omeprazole/imidazoles/amoxicillin or clarithromycin (mean ER 83.4 vs. 83.5% vs. 93%, NS). The best mean eradication rate, 93.5%, was attained with omeprazole/bismuth/imidazoles/tetracycline. Subgroup analysis revealed a significant correlation between the dose/duration of therapy and the ER for most combinations. The best cost:benefit ratio was demonstrated for omeprazole/imidazoles/clarithromycin (triple therapy including acid suppression).
The optimal cost:benefit ratio will be achieved by treatment for 1 wk with omeprazole (20 mg/day), imidazoles (such as metronidazole 2 x 400 mg/day), and clarithromycin (2 x 250 mg/day). If dual therapy is taken into account in terms of simplicity and few side effects, the treatment success in the combination of omeprazole ( > or = 2 x 20 mg/day) and amoxicillin ( > or = 2 g/day) or clarithromycin ( > or = 1 g/day), each given for 2 wk, is highly dependent on optimal drug dosage.
本综述提供了关于幽门螺杆菌（HP）试验的最新概述，重点关注药物剂量和成本效益比。
进行文献综述，分析了针对13562例患者的362种治疗方法。
统计评估显示以下平均幽门螺杆菌根除率（ER）：单一疗法为11.7%，无抑酸的二联疗法为50.7%，包括抑酸的二联疗法为59.8%，无抑酸的三联疗法为78.1%，包括抑酸的三联疗法为77.5%，多重联合疗法为89.1%（所有组之间的差异，p<0.001）。在二联疗法中，奥美拉唑/阿莫西林或克拉霉素（平均根除率65.9%对67.6%，无显著差异）显示出比其他组合更好的效果。三联疗法中，铋剂/咪唑类/四环素联合使用或奥美拉唑/咪唑类/阿莫西林或克拉霉素联合使用取得了良好效果（平均根除率83.4%对83.5%对93%，无显著差异）。奥美拉唑/铋剂/咪唑类/四环素的平均根除率最高，为93.5%。亚组分析显示，对于大多数组合，治疗剂量/疗程与根除率之间存在显著相关性。奥美拉唑/咪唑类/克拉霉素（包括抑酸的三联疗法）显示出最佳的成本效益比。
使用奥美拉唑（20毫克/天）、咪唑类（如甲硝唑2×400毫克/天）和克拉霉素（2×250毫克/天）治疗1周可实现最佳成本效益比。如果考虑到二联疗法的简便性和较少的副作用，奥美拉唑（≥2×20毫克/天）与阿莫西林（≥2克/天）或克拉霉素（≥1克/天）联合使用，每种药物服用2周，治疗成功高度依赖于最佳药物剂量。
