Penston J G, McColl K E
Scunthorpe General Hospital, Scunthorpe.
Br J Clin Pharmacol. 1997 Mar;43(3):223-43. doi: 10.1046/j.1365-2125.1997.00551.x.
The purpose of the present review was to determine objectively the optimal treatment for the eradication of H. pylori amongst the currently used regimens. A comprehensive literature search provided a data-base relating to the following treatments: dual therapy with an anti-secretory drug plus either amoxycillin or clarithromycin; standard triple therapy, with or without additional anti-secretory drugs; proton pump inhibitor triple therapy; and H2-receptor antagonist triple therapy. Emphasis was placed on intention-to-treat analyses of eradication rates using all of the available evidence. The criteria used to select the optimal treatment were efficacy (eradication rates), frequency of side-effects, simplicity of the regimen (number of tablets per day and duration of treatment) and cost. The analysis showed that proton pump inhibitor triple therapy (that is, a proton pump inhibitor plus any two of amoxycillin, clarithromycin or a nitroimidazole) was the preferred treatment for the eradication of H. pylori. In particular, the 1-week, low-dose regimen with omeprazole plus clarithromycin plus tinidazole produced the highest eradication rates (> 90%) with the lowest frequency of side-effects and at only modest cost.
本综述的目的是客观确定当前使用的治疗方案中根除幽门螺杆菌的最佳治疗方法。全面的文献检索提供了与以下治疗方法相关的数据库：抗分泌药物与阿莫西林或克拉霉素联合的双联疗法；标准三联疗法，有无额外的抗分泌药物；质子泵抑制剂三联疗法；以及H2受体拮抗剂三联疗法。重点是利用所有现有证据对根除率进行意向性分析。用于选择最佳治疗方法的标准包括疗效（根除率）、副作用发生率、治疗方案的简易程度（每日片剂数量和治疗持续时间）和成本。分析表明，质子泵抑制剂三联疗法（即质子泵抑制剂加阿莫西林、克拉霉素或硝基咪唑中的任意两种）是根除幽门螺杆菌的首选治疗方法。特别是，奥美拉唑加克拉霉素加替硝唑的1周低剂量方案产生了最高的根除率（>90%），副作用发生率最低，成本也仅适中。
