Conventional triple therapies for Helicobacter pylori (H. pylori ) eradication have recently shown a disappointing reduction in effectiveness in many countries. The main reason for failure was found to be bacterial r... Conventional triple therapies for Helicobacter pylori (H. pylori ) eradication have recently shown a disappointing reduction in effectiveness in many countries. The main reason for failure was found to be bacterial resistance to one of the most commonly used antibiotics, clarithromycin. An additional problem for conventional triple therapy is the high rate of resistance to metronidazole found in Europe, America and Asia. In Italy, in the last 15 years a 2-fold increase in resistance has occurred. A recent study of the whole of Italy included about 20 patients from each region at the first endoscopic diagnosis of H. pylori infection. The most surprising result was the patchy distribution of resistance, which was almost absent in two regions (one northern and one southern), although the highest prevalence was found in some regions of the South. In the paediatricpopulation we found a 25% prevalence of resistance in a sample of H. pylori positive children observed between 2002 and 2007, mirroring data obtained in southern European countries. Clarithromycin resistance assessment is currently based on phenotypic detection performed after culture the agar dilution method or E-test, and genotypic methods based on polymerase chain reaction (PCR). In a recent comparative study we found a 71.2% agreement between the two methods. Culture-free techniques are highly accurate in finding even minimal traces of genotypically resistant strains. Moreover, PCR-based tools are accurate in detecting a heteroresistant status, defined as the co-existence of some strains that are susceptible and some resistant to the same antibiotic in an individual patient. Three point mutations, namely A2143G , A2142G and A2142C , are responsible for 90% of cases of primary clarithromycin resistance in H. pylori strains isolated in Western countries, although we previously demonstrated that the presence of the A2143G mutation, but not A2142G or A2142C , significantly lowered the H. pylori eradication rate. Treatment failure has considerable cost/benef展开更多
Aim To evaluate the efficacy and cost-effectiveness of one-week regiment of quadruple and triple therapy containing:Lansoprazle(L),colloidal bismuth subciteate(B),amoxicillin(A),metrnidozole(M) and furazolidone(F).Met...Aim To evaluate the efficacy and cost-effectiveness of one-week regiment of quadruple and triple therapy containing:Lansoprazle(L),colloidal bismuth subciteate(B),amoxicillin(A),metrnidozole(M) and furazolidone(F).Methods 227 patients with duodenal ulcer(DU) or non-ulcer dyspepsia (NUD) confirmed by endoscopy were received LAFB,LAM or LAF,twice daily for 7 days.Endoscopy was performed in DU and 14 C-UBT was performed in NUD 4 weeks after completion of treatment.Results (1)The eradication rate of H.pylori by LAFB,LAM and LAF were 96.30%,84.51% and 70.59% respectively(LAFB vs LAF and LAF,P<0.05;LAFB vs LAM P<0.01).The healing rate of DU had no difference between three regiment P<0.05).The cost-effectiveness analysis on eradication of H.pylori showed that cost/effectiveness (C/E) of LAFB is the lowest.(2)The healing rate of DU ulcer in H.pylori eradicated patients was higher than that in uneradicated ones(98.94% vs 50%,P<0.01).The rate of ulcer recurrent of year was lower in H.pylori eradicated patients than that in uneradicated patients(2.15% vs 71.42%,P<0.01).(3)The rate of relieving symptom and recurrenting symptom in one year had no difference between H.pylori eradicated patients and uneradicated patiens in NUD(71.74% vs 70% and 53.03 vs 50,P>0.05).Conclusions The efficacy of one week regiment of quadruple therapy is higher than that in triple therapy but the side effect was not higher.The higher eradication rate is caused by combination of furazolidone,bacause it is low resis tant to H.pylori.It is also a cost-saving strategy.Eradication of H.pylori infection could improve ulcer healing and decrease the rate of ulcer recurrent but is not likely to relieve symptomes in NUD patients.展开更多
文摘 Conventional triple therapies for Helicobacter pylori (H. pylori ) eradication have recently shown a disappointing reduction in effectiveness in many countries. The main reason for failure was found to be bacterial resistance to one of the most commonly used antibiotics, clarithromycin. An additional problem for conventional triple therapy is the high rate of resistance to metronidazole found in Europe, America and Asia. In Italy, in the last 15 years a 2-fold increase in resistance has occurred. A recent study of the whole of Italy included about 20 patients from each region at the first endoscopic diagnosis of H. pylori infection. The most surprising result was the patchy distribution of resistance, which was almost absent in two regions (one northern and one southern), although the highest prevalence was found in some regions of the South. In the paediatricpopulation we found a 25% prevalence of resistance in a sample of H. pylori positive children observed between 2002 and 2007, mirroring data obtained in southern European countries. Clarithromycin resistance assessment is currently based on phenotypic detection performed after culture the agar dilution method or E-test, and genotypic methods based on polymerase chain reaction (PCR). In a recent comparative study we found a 71.2% agreement between the two methods. Culture-free techniques are highly accurate in finding even minimal traces of genotypically resistant strains. Moreover, PCR-based tools are accurate in detecting a heteroresistant status, defined as the co-existence of some strains that are susceptible and some resistant to the same antibiotic in an individual patient. Three point mutations, namely A2143G , A2142G and A2142C , are responsible for 90% of cases of primary clarithromycin resistance in H. pylori strains isolated in Western countries, although we previously demonstrated that the presence of the A2143G mutation, but not A2142G or A2142C , significantly lowered the H. pylori eradication rate. Treatment failure has considerable cost/benef
文摘Aim To evaluate the efficacy and cost-effectiveness of one-week regiment of quadruple and triple therapy containing:Lansoprazle(L),colloidal bismuth subciteate(B),amoxicillin(A),metrnidozole(M) and furazolidone(F).Methods 227 patients with duodenal ulcer(DU) or non-ulcer dyspepsia (NUD) confirmed by endoscopy were received LAFB,LAM or LAF,twice daily for 7 days.Endoscopy was performed in DU and 14 C-UBT was performed in NUD 4 weeks after completion of treatment.Results (1)The eradication rate of H.pylori by LAFB,LAM and LAF were 96.30%,84.51% and 70.59% respectively(LAFB vs LAF and LAF,P<0.05;LAFB vs LAM P<0.01).The healing rate of DU had no difference between three regiment P<0.05).The cost-effectiveness analysis on eradication of H.pylori showed that cost/effectiveness (C/E) of LAFB is the lowest.(2)The healing rate of DU ulcer in H.pylori eradicated patients was higher than that in uneradicated ones(98.94% vs 50%,P<0.01).The rate of ulcer recurrent of year was lower in H.pylori eradicated patients than that in uneradicated patients(2.15% vs 71.42%,P<0.01).(3)The rate of relieving symptom and recurrenting symptom in one year had no difference between H.pylori eradicated patients and uneradicated patiens in NUD(71.74% vs 70% and 53.03 vs 50,P>0.05).Conclusions The efficacy of one week regiment of quadruple therapy is higher than that in triple therapy but the side effect was not higher.The higher eradication rate is caused by combination of furazolidone,bacause it is low resis tant to H.pylori.It is also a cost-saving strategy.Eradication of H.pylori infection could improve ulcer healing and decrease the rate of ulcer recurrent but is not likely to relieve symptomes in NUD patients.
