Pipkin G A, Williamson R, Wood J R
Department of Gastroenterology, Glaxo Wellcome Research and Development, Uxbridge, UK.
Aliment Pharmacol Ther. 1998 Sep;12(9):823-37. doi: 10.1046/j.1365-2036.1998.00405.x.
One-week triple therapies have been endorsed as the treatment regimens of choice for eradication of Helicobacter pylori infection. Those that include clarithromycin appear to be the most effective.
To review reports of triple therapies that include clarithromycin.
Reports were identified from the literature to May 1998. The variation between study designs prevents a formal meta-analysis. A measure of the relative efficacies of regimens has, however, been gained by comparison and by pooling of intention-to-treat eradication rates.
One hundred and ninety-two studies were identified which included 264 treatment arms of a 1-week triple therapy composed of clarithromycin with amoxycillin or a nitroimidazole (metronidazole or tinidazole), and either ranitidine bismuth citrate or a proton pump inhibitor (omeprazole, lansoprazole or pantoprazole). From reports of these studies, an intention-to-treat H. pylori eradication rate could be determined from 210 treatment arms of 151 studies.
There is little to choose between the efficacies of 1-week clarithromycin-based triple therapy eradication regimens. However, those comprising clarithromycin, a nitroimidazole and either ranitidine bismuth citrate or a high dose of omeprazole are, in general, the most effective. Against antibiotic-resistant strains of H. pylori, regimens including ranitidine bismuth citrate may be more effective than those including a proton pump inhibitor.
一周的三联疗法已被认可为根除幽门螺杆菌感染的首选治疗方案。其中包含克拉霉素的方案似乎最为有效。
综述包含克拉霉素的三联疗法的报告。
从文献中检索截至1998年5月的报告。研究设计的差异使得无法进行正式的荟萃分析。然而，通过比较和汇总意向性治疗根除率，获得了各方案相对疗效的一种衡量方法。
共识别出192项研究，其中包括264个治疗组，采用为期一周的三联疗法，即克拉霉素联合阿莫西林或硝基咪唑（甲硝唑或替硝唑），并联合枸橼酸铋雷尼替丁或质子泵抑制剂（奥美拉唑、兰索拉唑或泮托拉唑）。从这些研究的报告中，可以从151项研究的210个治疗组中确定意向性治疗的幽门螺杆菌根除率。
基于克拉霉素的一周三联疗法根除方案的疗效之间差异不大。然而，一般来说，包含克拉霉素、硝基咪唑以及枸橼酸铋雷尼替丁或高剂量奥美拉唑的方案最为有效。对于幽门螺杆菌耐药菌株，包含枸橼酸铋雷尼替丁的方案可能比包含质子泵抑制剂的方案更有效。
