序贯疗法与标准三联疗法根除幽门螺杆菌的疗效比较
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摘要
目的
观察序贯疗法根除幽门螺杆菌是否优于标准三联疗法。
方法
210例HP阳性的患者随机分为两组。序贯疗法组前5天应用埃索美拉唑40mg日两次+阿莫西林1000mg日两次,后5天埃索美拉唑40mg日两次+克拉霉素500mg日两次+替硝唑500mg日两次,标准三联疗法组应用10天埃索美拉唑40mg日两次+阿莫西林1000mg日两次+克拉霉素500mg日两次。4周后复查HP。
结果
序贯疗法组根除率90.9%,标准三联疗法组根除率70%。
结论
序贯疗法根除幽门螺杆菌疗效明显优于标准三联疗法。
Object
To determine whether sequential treatment eradicates H. pylori infection better than standard triple-drug therapy.
Methods
Sequential regimen (40 mg of Esomeprazole,1000mg of amoxicillin each administered twice daily for the first 5 days, followed by 40 mg of Esomeprazole,500 mg of clarithromycin, and 500 mg of tinidazole, each administered twice daily for the remaining 5 days.)or standard therapy (40 mg of Esomeprazole,500 mg of clarithromycin, and 1000mg of amoxicillin,each administered twice daily).
Results
The eradication rate of sequential therpy was 90.9% and that of Standard Triple-Drug Therapy was 70%.
Conclusion
Sequential therapy is more effective than Standard Triple-Drug Therapy.
观察序贯疗法根除幽门螺杆菌是否优于标准三联疗法。
方法
210例HP阳性的患者随机分为两组。序贯疗法组前5天应用埃索美拉唑40mg日两次+阿莫西林1000mg日两次,后5天埃索美拉唑40mg日两次+克拉霉素500mg日两次+替硝唑500mg日两次,标准三联疗法组应用10天埃索美拉唑40mg日两次+阿莫西林1000mg日两次+克拉霉素500mg日两次。4周后复查HP。
结果
序贯疗法组根除率90.9%,标准三联疗法组根除率70%。
结论
序贯疗法根除幽门螺杆菌疗效明显优于标准三联疗法。
Object
To determine whether sequential treatment eradicates H. pylori infection better than standard triple-drug therapy.
Methods
Sequential regimen (40 mg of Esomeprazole,1000mg of amoxicillin each administered twice daily for the first 5 days, followed by 40 mg of Esomeprazole,500 mg of clarithromycin, and 500 mg of tinidazole, each administered twice daily for the remaining 5 days.)or standard therapy (40 mg of Esomeprazole,500 mg of clarithromycin, and 1000mg of amoxicillin,each administered twice daily).
Results
The eradication rate of sequential therpy was 90.9% and that of Standard Triple-Drug Therapy was 70%.
Conclusion
Sequential therapy is more effective than Standard Triple-Drug Therapy.
引文
1 Malfertheiner P, Megraud F, O'Morain C, Bazzoli F, El-Omar E, Graham D, et al. Current concepts in the management of Helicobacter pylori infection:the Maastricht III Consensus Report. Gut 2007;56(6):772-781.
2 Malfertheiner P. Helicobacter pylori-a timeless source of lessons and research initiatives. Helicobacter 2007;Suppl 2:85-89.
3 Janulaityte-Gunther D, Kupcinskas L, Pavilonis A, Valuckas K, Percival Andersen L, Wadstrom T. Helicobacter pylori antibodies and gastric cancer:a genderrelated difference FEMS Immunol Med Microbiol 2005;44(2):191-195.
4 Moayyedi P, Deeks J, Talley NJ, Delaney B, Forman D. An update ofthe Cochrane systematic review of Helicobacter pylori eradication therapy in nonulcer dyspepsia:Resolving the discrepancy between systematic reviews. Am J Gastroenterol 2003;98:2621-2626.
5 Abraham NS, Moayyedi P, Daniels B, Veldhuyzen Van Zanten SJ.Systematic review:The methodological quality of trials affects estimates of treatment efficacy in functional (non-ulcer) dyspepsia.Aliment Pharmacol Ther 2004;19:631-41.
6 中华医学会消化病学分会.第三次全国幽门螺杆菌感染若干问题共识报告.中华内科杂志,2008,47(4)：346-349.
7 Calvet X, Garcia N, Lopez T, Gisbert JP, Gene E, Roque M. A meta-analysis of short versus long therapy with a proton pump inhibitor,clarithromycin and either metronidazole or amoxicillin for treating Helicobacter pylori infection. Aliment Pharmacol Ther 2000; 14:603-609.
8 Laine L, Fennerty MB, Osato M, Sugg J, Suchower L, Probst P,etal.Esomeprazolebased Helicobacter pylori eradication therapy and the effect of antibiotic resistance:results of three US multicenter, double-blind trials. Am J GastroEnterol.2000;95:3393-3398.
9 Vakil N, Lanza F, Schwartz H, Barth J. Seven-day therapy for Helicobacter pylori in the United States. Aliment Pharmacol Ther.2004;20:99-107.
10 Laheij RJ, Rossum LG, Jansen JB, Straatman H, Verbeek AL. Evaluation of treatment regimens to cure Helicobacter pylori infection-a meta-analysis. AlimentPharmacol Ther.1999;13: 857-864.
11 Megraud F, Lamouliatte H. Review article; the treatment of refractory Helicobacter pylori infection. Aliment Phar-Macol Ther 2003;17,11:1333.
12 Alarcon T, Vega AE, Domingo D, Martinez MJ, Lopez-Brea M. Clarithromycin resistance among Helicobacter pylori strains isolated from children:Prevalence and study of mechanism of resistance by PCR-restriction fragment length polymorphism analysis. J Clin Microbiol 2003; 41(1):486-489.
13 Ro(?)ynek E, Dzier(?)anowska.Fangrat K, Jozwiak P, Madalinski K, Dzier(?)anowska D. Primary resistance of Helicobacter pylori to antimicrobial agents in Polish children. Acta Microbiol Pol 2002; 51 (3):255-263.
14 Vakil N, Hahn B, McSorley D. Clarithromycin-resistant helicobacter pylori in patients with duodenal ulcer in the United States. Am JGastroenterol 1998; 93:1432-1435.
15成虹,胡伏莲.北京地区幽门螺杆菌耐药情况及其耐药趋势[J].中华医学杂志,2005,85(39)：2754-2757.
16罗红春,吕琳,杨致邦。重庆地区幽门螺杆菌对甲硝唑的耐药性和耐药机制的研究。中国抗生素杂志,2008,33(8)：499-502.
17 Kalach N,Bergeret M, Benhamou PH,Dupont Ch, Raymond J. High levels of resistance to metronidazole and clarithromycin in Helicobacter pylori strains in children. J Clin Microbiol 2001;39(1):394-397.
18 Watanabe K,Tanaka A,Imase K,et al.Amoxicillin resistance in Helicobacter pylori:studies from Tokyo,J apan from 1985 to2003[J].Helicobacter,2005,10(1):4211.
19 Center of Gastrology, Cracow, Poland. Efficacy of HeliCobacter pylori eradication taking into account its resistance to antibiotics. Journal of Physiology And pharmacology 2006, 57,Supp 3,123-141.
20 Peterson WL.The role of antisecretory drugs in the treatment of Helicobacter pylori infection. Aliment Pharmacol Ther 1997; 11(Suppl.1):21-25.
21 Benini L, Castellani G, Bardelli E, et al. Omeprazole causes delay in gastric emptying of digestible meals. Dig Dis Sci 1996;41:469-474.
22 De Francesco V, Margiotta M, Zullo A, Hassan C, Troiani L, Burattini O,et al. Clarithromycin-resistant genotypes and eradication of Helicobacter pylori. Ann Intern Med. 2006;144:94-100.
1 Thomson AB, Barkun AN, Armstrong D, Chiba N, White RJ, Daniels S, etal. The prevalence of clinicall significant endoscopic findings in primary carepatientswith uninvestigated dyspepsia: the Canadian Adult Dyspepsia Empiric Treatment-Prompt Endoscopy (CADET-PE) study [Published correction appears in Aliment Pharmacol Ther 2004;20:702].Aliment Pharmacol Ther 2003;17:1481-91.
2 Everhart JE. Recent developments in the epidem-Iology of Helicobacter pylori. Gastroenterol Clin North Am 2000;29:559-78.
3 Lacy BE, Rosemore J. Helicobacter pylori:ulcers and more:the beginning of an era. J Nutr 2001;131:2789S-93S.
4 Gold BD, Colletti RB, Abbott M, Czinn SJ, Elitsur Y, Hassall E,et al.North American Society for Pediatric Gastroenterology and Nutrition.Helicobacter pylori infection in children:recommenda-tions for diagnosis and treatment. J Pediatr Gastroenterol Nutr2000;31:490-7.
5 Parsonnet J. The incidence of Helicobacter pylori infection. Aliment Pharmacol ther1995;9(suppl2):45-51.
6 Bazzoli F, Zagari M, Pozzato P, et al. Evaluation of short-term low-dose triple therapy for the eradication of Helicobacter pylori by factorial designin a randomized, double-blind, controlled study[J]. Aliment Pharmacol Ther,1998,12(5):439-445.
7 Lind T, Veldhuyzen van Zanten S, Unge P, et al. Eradication of Helicobacter pylori using one-week triple therapies combining omeprazole with two antimicrobials:the mact study[J].Helicobacter,1996,1(3):138-144.
8 McColm AA, McLaren A, Klinkert G, et al. Ranitidine bismuth citrate:a novel anti-ulcer agent with different physico-chemical characteristics and improved biological activity to a bismuth citrate-ranitidine admixture [J]. Aliment Pharmacol Ther,1996,10(3):241-250.
9 Kamiberoglou D, Polymeros D, Sanidas I, et al. Comparison of 1-weekvs.2-or 4-week therapy regimens with ranitidine bismuth citrate plustwo antibiotics for Helicobacter pylorieradication[J]. AlimentPharmacol Ther,2001,15(9):1493-1497.
10 Parente F, Cucino C, Bianchi Porro G. Treatment options for patients with Helicobacter Pylori infection resistant to one ormore eradication attempts. Dig Liver Dis 2003;35:523-528.
11 Broutet N, Tchamgoue S, Pereira E, LamouliatteH, Salamon R,Megraud F. Risk factors for failure of Helicobacter pylori therapy--results of an individual data analysis of 2751 patients. Aliment Pharmacol Ther 2003;17:99-109.
12 Crone J, Granditsch G, Huber WD, Binder CInnerhoferA,Amann G, Hirschl AM. Helicobacter pylori in children and adolescents:increase of primary clarithromycin resistance,1997-2000. J Pediatr Gastroenterol Nutr 2003;36:368-371.
13 Perri F, Qasim A, Marras L, O'Morain C. Treatment of Helicobacter pylori infection. Helicobacter 2003;8 Suppl 1:53-60.
14 Xia HX, Fan XG, Talley NJ. Clarithromycin resistance in Helicobacter pylori and its clinical relevance [J].World J Gastroenterol,1999,5(3):263-266.
15 Qasim A, O'Morain CA. Review article:treatment of Helicobater pylori infection and factors infl uencing eradication. Aliment Pharmacol Ther 2002; 16:24-30.
16 Malfertheiner P, Megraud F, O'Morain C, Hungin AP, Jones R,Axon A, Graham DY, Tytgat G. Current concepts in the management of Helicobacter pylori infectionthe Maastricht 2-2000Consensus Report. Aliment Pharmacol Ther 2002; 16:167-180.
17 Rinaldi V, Zullo A, De Francesco V, Hassan C, Winn S, StoppinoV, Faleo D, Attili AF. Helicobacter pylori eradication with proton pump inhibitor based triple therapies and re-treatment with ranitidine bismuth citrate-based triple therapy. AlimentPharmacol Ther 1999;13:163-168.
18 Zullo A, Hassan C, Campo SM, Lorenzetti R, Febbraro I, DeMatthaeis M, Porto D, Morini S. A triple therapy regimen afterfailed Helicobacter pylori treatments. Aliment Pharmacol Ther 2001;15:1193-1197.
19 Gisbert JP, Gisbert JL, Marcos S, Gravalos RG,Carpio D,Pajares JM. Seven-da'rescue'therapy after Helicobacter pyloritreatment failure:omeprazole, bismuth, tetracycline and metronidazole vs. ranitidine bismuth citrate, tetracycline and metronidazole. AlimentPharmacol Ther 1999; 13: 1311-1316.
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44 Heep M, Kist M, Strobel S, Beck D, Lehn N. Secondary resistance among 554 isolates of Helicobacter pylori after failure of therapy. Eur J Clin Microbiol Infect Dis 2000; 19:538-541.
45 Pilotto A, Franceschi M, Rassu M, Furlan F,Scagnelli M. In vitro activity of rifabutin against strains of Helicobacter pylori resistant to metronidazole and clarithromycin. Am J Gastroenterol2000;95:833-834.
46 Fujimura S, Kato S, Kawamura T, Watanabe A. In vitro activity of rifampicin against Helicobacter pylori isolated from children and adults. J Antimicrob Chemother 2002;49:541-543.
47 Vaira D,Zullo A,Vakil N,et al. Sequential therapy versus standard t rip le2drug therapy for Helicobacter pylori eradication:a randomized t rial [J].Ann Intern Med,2007,146(8):556.
2 Malfertheiner P. Helicobacter pylori-a timeless source of lessons and research initiatives. Helicobacter 2007;Suppl 2:85-89.
3 Janulaityte-Gunther D, Kupcinskas L, Pavilonis A, Valuckas K, Percival Andersen L, Wadstrom T. Helicobacter pylori antibodies and gastric cancer:a genderrelated difference FEMS Immunol Med Microbiol 2005;44(2):191-195.
4 Moayyedi P, Deeks J, Talley NJ, Delaney B, Forman D. An update ofthe Cochrane systematic review of Helicobacter pylori eradication therapy in nonulcer dyspepsia:Resolving the discrepancy between systematic reviews. Am J Gastroenterol 2003;98:2621-2626.
5 Abraham NS, Moayyedi P, Daniels B, Veldhuyzen Van Zanten SJ.Systematic review:The methodological quality of trials affects estimates of treatment efficacy in functional (non-ulcer) dyspepsia.Aliment Pharmacol Ther 2004;19:631-41.
6 中华医学会消化病学分会.第三次全国幽门螺杆菌感染若干问题共识报告.中华内科杂志,2008,47(4)：346-349.
7 Calvet X, Garcia N, Lopez T, Gisbert JP, Gene E, Roque M. A meta-analysis of short versus long therapy with a proton pump inhibitor,clarithromycin and either metronidazole or amoxicillin for treating Helicobacter pylori infection. Aliment Pharmacol Ther 2000; 14:603-609.
8 Laine L, Fennerty MB, Osato M, Sugg J, Suchower L, Probst P,etal.Esomeprazolebased Helicobacter pylori eradication therapy and the effect of antibiotic resistance:results of three US multicenter, double-blind trials. Am J GastroEnterol.2000;95:3393-3398.
9 Vakil N, Lanza F, Schwartz H, Barth J. Seven-day therapy for Helicobacter pylori in the United States. Aliment Pharmacol Ther.2004;20:99-107.
10 Laheij RJ, Rossum LG, Jansen JB, Straatman H, Verbeek AL. Evaluation of treatment regimens to cure Helicobacter pylori infection-a meta-analysis. AlimentPharmacol Ther.1999;13: 857-864.
11 Megraud F, Lamouliatte H. Review article; the treatment of refractory Helicobacter pylori infection. Aliment Phar-Macol Ther 2003;17,11:1333.
12 Alarcon T, Vega AE, Domingo D, Martinez MJ, Lopez-Brea M. Clarithromycin resistance among Helicobacter pylori strains isolated from children:Prevalence and study of mechanism of resistance by PCR-restriction fragment length polymorphism analysis. J Clin Microbiol 2003; 41(1):486-489.
13 Ro(?)ynek E, Dzier(?)anowska.Fangrat K, Jozwiak P, Madalinski K, Dzier(?)anowska D. Primary resistance of Helicobacter pylori to antimicrobial agents in Polish children. Acta Microbiol Pol 2002; 51 (3):255-263.
14 Vakil N, Hahn B, McSorley D. Clarithromycin-resistant helicobacter pylori in patients with duodenal ulcer in the United States. Am JGastroenterol 1998; 93:1432-1435.
15成虹,胡伏莲.北京地区幽门螺杆菌耐药情况及其耐药趋势[J].中华医学杂志,2005,85(39)：2754-2757.
16罗红春,吕琳,杨致邦。重庆地区幽门螺杆菌对甲硝唑的耐药性和耐药机制的研究。中国抗生素杂志,2008,33(8)：499-502.
17 Kalach N,Bergeret M, Benhamou PH,Dupont Ch, Raymond J. High levels of resistance to metronidazole and clarithromycin in Helicobacter pylori strains in children. J Clin Microbiol 2001;39(1):394-397.
18 Watanabe K,Tanaka A,Imase K,et al.Amoxicillin resistance in Helicobacter pylori:studies from Tokyo,J apan from 1985 to2003[J].Helicobacter,2005,10(1):4211.
19 Center of Gastrology, Cracow, Poland. Efficacy of HeliCobacter pylori eradication taking into account its resistance to antibiotics. Journal of Physiology And pharmacology 2006, 57,Supp 3,123-141.
20 Peterson WL.The role of antisecretory drugs in the treatment of Helicobacter pylori infection. Aliment Pharmacol Ther 1997; 11(Suppl.1):21-25.
21 Benini L, Castellani G, Bardelli E, et al. Omeprazole causes delay in gastric emptying of digestible meals. Dig Dis Sci 1996;41:469-474.
22 De Francesco V, Margiotta M, Zullo A, Hassan C, Troiani L, Burattini O,et al. Clarithromycin-resistant genotypes and eradication of Helicobacter pylori. Ann Intern Med. 2006;144:94-100.
1 Thomson AB, Barkun AN, Armstrong D, Chiba N, White RJ, Daniels S, etal. The prevalence of clinicall significant endoscopic findings in primary carepatientswith uninvestigated dyspepsia: the Canadian Adult Dyspepsia Empiric Treatment-Prompt Endoscopy (CADET-PE) study [Published correction appears in Aliment Pharmacol Ther 2004;20:702].Aliment Pharmacol Ther 2003;17:1481-91.
2 Everhart JE. Recent developments in the epidem-Iology of Helicobacter pylori. Gastroenterol Clin North Am 2000;29:559-78.
3 Lacy BE, Rosemore J. Helicobacter pylori:ulcers and more:the beginning of an era. J Nutr 2001;131:2789S-93S.
4 Gold BD, Colletti RB, Abbott M, Czinn SJ, Elitsur Y, Hassall E,et al.North American Society for Pediatric Gastroenterology and Nutrition.Helicobacter pylori infection in children:recommenda-tions for diagnosis and treatment. J Pediatr Gastroenterol Nutr2000;31:490-7.
5 Parsonnet J. The incidence of Helicobacter pylori infection. Aliment Pharmacol ther1995;9(suppl2):45-51.
6 Bazzoli F, Zagari M, Pozzato P, et al. Evaluation of short-term low-dose triple therapy for the eradication of Helicobacter pylori by factorial designin a randomized, double-blind, controlled study[J]. Aliment Pharmacol Ther,1998,12(5):439-445.
7 Lind T, Veldhuyzen van Zanten S, Unge P, et al. Eradication of Helicobacter pylori using one-week triple therapies combining omeprazole with two antimicrobials:the mact study[J].Helicobacter,1996,1(3):138-144.
8 McColm AA, McLaren A, Klinkert G, et al. Ranitidine bismuth citrate:a novel anti-ulcer agent with different physico-chemical characteristics and improved biological activity to a bismuth citrate-ranitidine admixture [J]. Aliment Pharmacol Ther,1996,10(3):241-250.
9 Kamiberoglou D, Polymeros D, Sanidas I, et al. Comparison of 1-weekvs.2-or 4-week therapy regimens with ranitidine bismuth citrate plustwo antibiotics for Helicobacter pylorieradication[J]. AlimentPharmacol Ther,2001,15(9):1493-1497.
10 Parente F, Cucino C, Bianchi Porro G. Treatment options for patients with Helicobacter Pylori infection resistant to one ormore eradication attempts. Dig Liver Dis 2003;35:523-528.
11 Broutet N, Tchamgoue S, Pereira E, LamouliatteH, Salamon R,Megraud F. Risk factors for failure of Helicobacter pylori therapy--results of an individual data analysis of 2751 patients. Aliment Pharmacol Ther 2003;17:99-109.
12 Crone J, Granditsch G, Huber WD, Binder CInnerhoferA,Amann G, Hirschl AM. Helicobacter pylori in children and adolescents:increase of primary clarithromycin resistance,1997-2000. J Pediatr Gastroenterol Nutr 2003;36:368-371.
13 Perri F, Qasim A, Marras L, O'Morain C. Treatment of Helicobacter pylori infection. Helicobacter 2003;8 Suppl 1:53-60.
14 Xia HX, Fan XG, Talley NJ. Clarithromycin resistance in Helicobacter pylori and its clinical relevance [J].World J Gastroenterol,1999,5(3):263-266.
15 Qasim A, O'Morain CA. Review article:treatment of Helicobater pylori infection and factors infl uencing eradication. Aliment Pharmacol Ther 2002; 16:24-30.
16 Malfertheiner P, Megraud F, O'Morain C, Hungin AP, Jones R,Axon A, Graham DY, Tytgat G. Current concepts in the management of Helicobacter pylori infectionthe Maastricht 2-2000Consensus Report. Aliment Pharmacol Ther 2002; 16:167-180.
17 Rinaldi V, Zullo A, De Francesco V, Hassan C, Winn S, StoppinoV, Faleo D, Attili AF. Helicobacter pylori eradication with proton pump inhibitor based triple therapies and re-treatment with ranitidine bismuth citrate-based triple therapy. AlimentPharmacol Ther 1999;13:163-168.
18 Zullo A, Hassan C, Campo SM, Lorenzetti R, Febbraro I, DeMatthaeis M, Porto D, Morini S. A triple therapy regimen afterfailed Helicobacter pylori treatments. Aliment Pharmacol Ther 2001;15:1193-1197.
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