Huang W H, Ho A S, Shyu R Y, Lee S C, Lee M M, Hsu C T
Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 1998 Aug;61(8):448-55.
Antimicrobial therapy is the recommended treatment for duodenal ulcer associated with Helicobacter pylori infection. The eradication of bismuth-based triple therapy with bismuth subcitrate, metronidazole and amoxicillin is limited by low compliance, drug resistance and side-effects. Two-week proton pump inhibitor (PPI)-based triple therapy has a higher eradication rate but is costly. This study was designed to compare the efficacy, patient compliance and cost of short-term PPI-based triple therapy with those of bismuth-based triple therapy.
Ninety patients with active duodenal ulcer disease and H pylori infection, proven with the 13C-urea breath test and CLO test (Campylobacter-like organism test) were treated randomly in three therapeutic groups: Group A, DeNol 120 mg, amoxicillin 500 mg and metronidazole 250 mg four times a day orally for 14 days; Group B, omeprazole 20 mg plus clarithromycin 500 mg twice a day and amoxicillin 500 mg four times a day for 14 days; Group C, omeprazole 20 mg, clarithromycin 250 mg and metronidazole 500 mg twice a day for seven days. Nizatidine 150 mg twice a day was given continuously following the end of anti-H pylori therapy for each group. Two months later, endoscopy, the CLO test and 13C-urea breath test were repeated to assess the eradication rate of H pylori and the ulcer-healing rate. Drug tolerance was evaluated by patients themselves by daily recording of any side-effects.
Eighty-four patients completed the entire course of therapy and evaluation for H pylori infection. The H pylori eradication rates in Groups A, B and C were 75% (21/28), 93% (26/28) and 89% (25/28), respectively (p = 0.466). The ulcer healing rate was 86% (24/28) in Group A and 89% (25/28) in Groups B and C (p = 0.764). A total of 74 patients (88%) were free from symptoms at the end of the triple therapy. Symptom relief was faster in patients with PPI-based triple therapy (Groups B and C) (days 3 and 4) than for patients with bismuth-based triple therapy (day 5). The cost of Group C therapy was lower than that for Groups A and B. There were no major side-effects in any of the patients.
One-week triple therapy with omeprazole, clarithromycin and metronidazole is highly effected for the eradication of H pylori. A therapeutic regime of one week's duration with lower cost, good compliance and mild side-effects may offer a good choice for treatment of duodenal ulcer associated with H pylori infection in clinical practice.
抗菌治疗是幽门螺杆菌感染相关十二指肠溃疡的推荐治疗方法。含枸橼酸铋钾、甲硝唑和阿莫西林的铋剂三联疗法根除率受依从性低、耐药性和副作用的限制。两周质子泵抑制剂（PPI）三联疗法根除率较高，但费用昂贵。本研究旨在比较短期PPI三联疗法与铋剂三联疗法的疗效、患者依从性和成本。
90例经13C-尿素呼气试验和CLO试验（类弯曲杆菌试验）证实患有活动性十二指肠溃疡疾病和幽门螺杆菌感染的患者被随机分为三个治疗组：A组，枸橼酸铋雷尼替丁120mg、阿莫西林500mg和甲硝唑250mg，每日口服4次，共14天；B组，奥美拉唑20mg加克拉霉素500mg，每日2次，阿莫西林500mg，每日4次，共14天；C组，奥美拉唑20mg、克拉霉素250mg和甲硝唑500mg，每日2次，共7天。每组抗幽门螺杆菌治疗结束后持续给予尼扎替丁150mg，每日2次。两个月后，重复进行内镜检查、CLO试验和13C-尿素呼气试验，以评估幽门螺杆菌根除率和溃疡愈合率。患者通过每日记录任何副作用来评估药物耐受性。
84例患者完成了幽门螺杆菌感染的整个治疗过程和评估。A、B、C组幽门螺杆菌根除率分别为75%（21/28）、93%（26/28）和89%（25/28）（p = 0.466）。A组溃疡愈合率为86%（24/28），B组和C组为89%（25/28）（p = 0.764）。三联疗法结束时共有74例患者（88%）无症状。基于PPI的三联疗法（B组和C组）患者症状缓解更快（第3天和第4天），而铋剂三联疗法患者为第5天。C组治疗费用低于A组和B组。所有患者均未出现严重副作用。
奥美拉唑、克拉霉素和甲硝唑一周三联疗法对根除幽门螺杆菌疗效显著。为期一周、成本较低、依从性好且副作用轻微的治疗方案可能为临床实践中治疗幽门螺杆菌感染相关十二指肠溃疡提供一个良好选择。
