Treiber G, Ammon S, Schneider E, Klotz U
Robert Bosch Hospital, Department of Gastroenterology, Stuttgart, Germany.
Helicobacter. 1998 Mar;3(1):54-8. doi: 10.1046/j.1523-5378.1998.08019.x.
Triple therapy regimens including two antibiotics plus acid suppression have become the new standard therapy in Helicobacter pylori eradication because of success rates of about 90%. However, these regimens are still costly, duration is about one week or less, and side-effects are not negligible. We therefore evaluated a new quadruple therapy, because theoretically a shorter duration of treatment may result in reduced costs, fewer side-effects, and possibly in a lower potential for antibiotic resistances.
Controlled, prospective pilot study including H. pylori-positive patients with gastric or duodenal ulcers or erosive gastritis, treated after failure of dual therapy (proton-pump-inhibitors or ranitidine plus amoxicillin) or for the first time. They were assigned to a one week triple standard therapy, consisting of metronidazole 400 mg bid + omeprazole 20 mg bid + clarithromycin 250 mg bid, or a newly created quadruple-regimen, which adds amoxicillin (1 g bid) to the above triple regimen. Each of the four drugs was given for 5 days. H. pylori status was checked by 13C urea breath test before and after four weeks of therapy.
A total of 71 patients were treated by quadruple therapy, and 42 patients were treated by triple therapy. The eradication rate of H. pylori for patients under quadruple treatment, without vs. with previous dual therapy, were 96% vs. 92% (42/44 vs. 22/24) by per protocol and 91% vs. 88% (42/46 vs. 22/25) by intention to treat analysis (comparisons not significant). No major side-effects were reported.
Five-day quadruple therapy (with omeprazole, metronidazole, clarithromycin and amoxicillin) represents an effective and safe new regimen for H. pylori eradication.
由于根除率约为90%，包含两种抗生素加抑酸剂的三联疗法已成为根除幽门螺杆菌的新标准疗法。然而，这些疗法成本仍然高昂，疗程约为一周或更短，且副作用不容小觑。因此，我们评估了一种新的四联疗法，因为从理论上讲，较短的治疗疗程可能会降低成本、减少副作用，并可能降低抗生素耐药性的潜在风险。
一项对照性前瞻性试点研究，纳入患有胃或十二指肠溃疡或糜烂性胃炎的幽门螺杆菌阳性患者，这些患者在双联疗法（质子泵抑制剂或雷尼替丁加阿莫西林）失败后接受治疗或首次接受治疗。他们被分配接受为期一周的三联标准疗法，即甲硝唑400毫克，每日两次 + 奥美拉唑20毫克，每日两次 + 克拉霉素250毫克，每日两次，或一种新创建的四联疗法，即在上述三联疗法中添加阿莫西林（1克，每日两次）。四种药物均服用5天。在治疗四周前后通过13C尿素呼气试验检查幽门螺杆菌感染状况。
共有71例患者接受四联疗法治疗，42例患者接受三联疗法治疗。四联疗法治疗的患者，无论之前是否接受过双联疗法，按方案分析的幽门螺杆菌根除率分别为96%和92%（42/44对22/24），意向性分析的根除率分别为91%和88%（42/46对22/25）（比较无显著性差异）。未报告严重副作用。
为期五天的四联疗法（使用奥美拉唑、甲硝唑、克拉霉素和阿莫西林）是一种有效且安全的根除幽门螺杆菌的新疗法。
