目的:由于对抗生素耐药率的增加,传统三联疗法方案在幽门螺旋杆菌(Hp)的根除率在逐渐下降,但对阿莫西林耐药率仍然比较低。因此我们观察含有艾司美拉唑、阿莫西林为主的两种不同方案在根除Hp相关慢性胃炎患者的临床疗效和安全性评价。方...目的:由于对抗生素耐药率的增加,传统三联疗法方案在幽门螺旋杆菌(Hp)的根除率在逐渐下降,但对阿莫西林耐药率仍然比较低。因此我们观察含有艾司美拉唑、阿莫西林为主的两种不同方案在根除Hp相关慢性胃炎患者的临床疗效和安全性评价。方法:纳入2015年1月至2016年12月在厦门大学附属第一医院确诊Hp感染且未接受过根除治疗的慢性胃炎患者200例,随机接受包含艾司美拉唑、阿莫西林的2种根除Hp的方案进行治疗。方案A(大剂量二联疗法):(艾司美拉唑40 mg bid+阿莫西林1.0 g tid)×14 d;方案B(含铋剂标准剂量四联疗法):(艾司美拉唑20 mg bid+枸橼酸铋钾220 mg bid+阿莫西林1.0 g bid+克拉霉素0.5 g bid)×14 d;根除治疗结束停药后4周及8周复查13C-尿素呼气试验。结果:2组患者基线资料差异无显著性(P>0.05)。193例患者最终完成试验。大剂量二联疗法ITT和PP根除率分别为88.0%(88/100)和91.7%(88/96);含铋剂标准剂量四联疗法ITT和PP根除率分别为92.0%(92/100)和94.8%(92/97);大剂量二联疗法、含铋剂标准剂量四联疗法二者相比差异无显著性(P>0.05)。两者的药物不良反应发生率分别为10.4%和13.4%,差异无显著性(P>0.05)。实验室检查方面2组中有个别患者出现一过性的ALT、AST增高,但均未达到正常值2倍上限;1例Cr、1例CK轻度增高;以上实验室异常指标2周后复查均已恢复正常。各组服药依从性较好,2组分别为97.9%和96.9%,差异无显著性(P>0.05)。成本-效果分析显示,大剂量二联疗法成本/效果比值(C/E)低于含铋剂标准剂量四联疗法。结论:大剂量二联疗法和含铋剂标准剂量四联疗法在根除Hp感染的慢性胃炎方面疗效相当,不良反应轻微,根除率高;在达到类似的根除效果情况下,大剂量二联疗法费用略低,可作为经典四联疗法的有效补充。展开更多
At present, the best rescue therapy for Helicobacter pylori(H. pylori) infection following failure of firstline eradication remains unclear. The Maastricht Ⅴ/Florence Consensus Report recommends bismuth quadruple the...At present, the best rescue therapy for Helicobacter pylori(H. pylori) infection following failure of firstline eradication remains unclear. The Maastricht Ⅴ/Florence Consensus Report recommends bismuth quadruple therapy, or fluoroquinolone-amoxicillin triple/quadruple therapy as the second-line therapy for H. pylori infection. Meta-analyses have shown that bismuth quadruple therapy and levofloxacin-amoxicillin triple therapy have comparable eradication rates, while the former has more adverse effects than the latter. There are no significant differences between the eradication rates of levofloxacin-amoxicillin triple and quadruple therapies. However, the eradication rates of both levofloxacin-containing treatments are suboptimal. An important caveat of levofloxacin-amoxicillin triple or quadruple therapy is poor eradication efficacy in the presence of fluoroquinolone resistance. High-dose dual therapy is an emerging second-line therapy and has an eradication efficacy comparable with levofloxacinamoxicillin triple therapy. Recently, a 10-d tetracyclinelevofloxacin(TL) quadruple therapy comprised of a proton pump inhibitor, bismuth, tetracycline and levofloxacin has been developed, which achieves a markedly higher eradication rate compared with levofloxacin-amoxicillin triple therapy(98% vs 69%) in patients with failure of standard triple, bismuth quadruple or non-bismuth quadruple therapy. The present article reviews current second-line anti-H. pylori regimens and treatment algorisms. In conclusion, bismuth quadruple therapy, levofloxacin-amoxicillin triple/quadruple therapy, high-dose dual therapy and TL quadruple therapy can be used as second-line treatment for H. pylori infection. Current evidence suggests that 10-d TL quadruple therapy is a simple and effective regimen, and has the potential to become a universal rescue treatment following eradication failure by all firstline eradication regimens for H. pylori infection.展开更多
文摘目的:由于对抗生素耐药率的增加,传统三联疗法方案在幽门螺旋杆菌(Hp)的根除率在逐渐下降,但对阿莫西林耐药率仍然比较低。因此我们观察含有艾司美拉唑、阿莫西林为主的两种不同方案在根除Hp相关慢性胃炎患者的临床疗效和安全性评价。方法:纳入2015年1月至2016年12月在厦门大学附属第一医院确诊Hp感染且未接受过根除治疗的慢性胃炎患者200例,随机接受包含艾司美拉唑、阿莫西林的2种根除Hp的方案进行治疗。方案A(大剂量二联疗法):(艾司美拉唑40 mg bid+阿莫西林1.0 g tid)×14 d;方案B(含铋剂标准剂量四联疗法):(艾司美拉唑20 mg bid+枸橼酸铋钾220 mg bid+阿莫西林1.0 g bid+克拉霉素0.5 g bid)×14 d;根除治疗结束停药后4周及8周复查13C-尿素呼气试验。结果:2组患者基线资料差异无显著性(P>0.05)。193例患者最终完成试验。大剂量二联疗法ITT和PP根除率分别为88.0%(88/100)和91.7%(88/96);含铋剂标准剂量四联疗法ITT和PP根除率分别为92.0%(92/100)和94.8%(92/97);大剂量二联疗法、含铋剂标准剂量四联疗法二者相比差异无显著性(P>0.05)。两者的药物不良反应发生率分别为10.4%和13.4%,差异无显著性(P>0.05)。实验室检查方面2组中有个别患者出现一过性的ALT、AST增高,但均未达到正常值2倍上限;1例Cr、1例CK轻度增高;以上实验室异常指标2周后复查均已恢复正常。各组服药依从性较好,2组分别为97.9%和96.9%,差异无显著性(P>0.05)。成本-效果分析显示,大剂量二联疗法成本/效果比值(C/E)低于含铋剂标准剂量四联疗法。结论:大剂量二联疗法和含铋剂标准剂量四联疗法在根除Hp感染的慢性胃炎方面疗效相当,不良反应轻微,根除率高;在达到类似的根除效果情况下,大剂量二联疗法费用略低,可作为经典四联疗法的有效补充。
文摘At present, the best rescue therapy for Helicobacter pylori(H. pylori) infection following failure of firstline eradication remains unclear. The Maastricht Ⅴ/Florence Consensus Report recommends bismuth quadruple therapy, or fluoroquinolone-amoxicillin triple/quadruple therapy as the second-line therapy for H. pylori infection. Meta-analyses have shown that bismuth quadruple therapy and levofloxacin-amoxicillin triple therapy have comparable eradication rates, while the former has more adverse effects than the latter. There are no significant differences between the eradication rates of levofloxacin-amoxicillin triple and quadruple therapies. However, the eradication rates of both levofloxacin-containing treatments are suboptimal. An important caveat of levofloxacin-amoxicillin triple or quadruple therapy is poor eradication efficacy in the presence of fluoroquinolone resistance. High-dose dual therapy is an emerging second-line therapy and has an eradication efficacy comparable with levofloxacinamoxicillin triple therapy. Recently, a 10-d tetracyclinelevofloxacin(TL) quadruple therapy comprised of a proton pump inhibitor, bismuth, tetracycline and levofloxacin has been developed, which achieves a markedly higher eradication rate compared with levofloxacin-amoxicillin triple therapy(98% vs 69%) in patients with failure of standard triple, bismuth quadruple or non-bismuth quadruple therapy. The present article reviews current second-line anti-H. pylori regimens and treatment algorisms. In conclusion, bismuth quadruple therapy, levofloxacin-amoxicillin triple/quadruple therapy, high-dose dual therapy and TL quadruple therapy can be used as second-line treatment for H. pylori infection. Current evidence suggests that 10-d TL quadruple therapy is a simple and effective regimen, and has the potential to become a universal rescue treatment following eradication failure by all firstline eradication regimens for H. pylori infection.
