以雷贝拉唑与加替沙星为基础的三联疗法治疗幽门螺杆菌感染的疗效观察

目的 研究以雷贝拉唑与加替沙星为基础的三联疗法根除幽门螺杆菌(Hp)的疗效、不良反应和药品的费用,以探讨临床更佳的根除Hp方案.方法 选择符合条件的300例患者,随机分为A、B、C 3组.A组:雷贝拉唑10mg bid,甲磺酸加替沙星200 mg bid,甲硝唑100 mg tid.B组:雷贝拉唑10 mg bid,甲磺酸加替沙星200 mg bid,阿莫西林500 mg tid.C组(对照组):雷贝拉唑10 mg bid,甲硝唑100 mg tid,阿莫西林500 mg tid.以上3组疗程均为2周.停药4周后复查胃镜或14C-UBT.结果 A组、B组、C组Hp根除率分别为91%、92%及87%,3组相比,差异无统计学意义(P＞0.05),未见发生严重不良反应者,A、B、C 3组的治疗费用分别为200.13元、210.76元和149.60元.结论 以雷贝拉唑与加替沙星为基础的三联疗法能有效、安全地根除Hp且能节省费用.     

Five-day oral cefditoren pivoxil versus 10-day oral amoxicillin for pediatric group A streptococcal pharyngotonsillitis

We prospectively compared the efficacy of oral cefditoren-pivoxil and conventional oral amoxicillin for pharyngotonsillitis caused by group A streptococcus in children. Either oral cefditoren-pivoxil (3 mg/kg t.i.d. for 5 days) or amoxicillin (10 mg/kg t.i.d. for 10 days) was administered to patients with group A streptococcal pharyngotonsillitis attending the pediatric outpatient clinic of Showa Hospital (Konan, Japan) between January and December 2006. Diagnosis was based on isolation of bacteria from a pharyngeal swab. Culture was always done to confirm eradication, and urinalysis and follow-up were performed at least once weekly for 4 weeks. Among 258 patients, 103 (aged 5.5 +/- 2.3 years) received cefditoren-pivoxil and 155 (aged 5.2 +/- 2.0 years) received amoxicillin. There were no significant between-group differences in age, sex, or symptoms. Eradication was confirmed in 99% (102/103) of the cefditoren-pivoxil group and 100% of the amoxicillin group. Recurrence within 4 weeks occurred in 8 and 15 patients in the cefditoren-pivoxil and amoxicillin groups, respectively, showing no significant difference in the recurrence rate, and all isolates had the same serotypes as before. There were no clinically significant adverse reactions or complications. The 50%/90% minimum inhibitory concentrations (microg/ml) of cefditoren-pivoxil and amoxicillin for the 258 isolates were < or =0.03/< or =0.03 and < or =0.03/0.06, respectively, so all isolates were susceptible to both agents. Because the efficacy for pediatric group A streptococcus pharyngotonsillitis was similar between oral cefditoren-pivoxil for 5 days and amoxicillin for 10 days, the shorter treatment period may make the former regimen preferable.     

Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis by bacterial and viral aetiology

ObjectiveWe aimed to assess the effects of amoxicillin treatment in adult patients presenting to primary care with a lower respiratory tract infection (LRTI) who were infected with a potential bacterial, viral, or mixed bacterial/viral infection.MethodsThis multicentre randomized controlled trial focused on adults with LRTI not suspected for pneumonia. Patients were randomized to receive either antibiotic (amoxicillin 1 g) or placebo three times daily for 7 consecutive days using computer-generated random numbers (follow-up 28 days). In this secondary analysis of the trial, symptom duration (primary outcome), symptom severity (scored 0–6), and illness deterioration (reconsultation with new or worsening symptoms, or hospital admission) were analysed in pre-specified subgroups using regression models. Subgroups of interest were patients with a (strictly) bacterial, (strictly) viral, or combined infection, and patients with elevated values of procalcitonin, C-reactive protein, or blood urea nitrogen.Results2058 patients (amoxicillin n = 1036; placebo n = 1022) were randomized. Treatment did not affect symptom duration (n = 1793). Patients from whom a bacterial pathogen only was isolated (n = 207) benefited from amoxicillin in that symptom severity (n = 804) was reduced by 0.26 points (95% CI −0.48 to −0.03). The odds of illness deterioration (n = 2024) was 0.24 (95% CI 0.11 to 0.53) times lower from treatment with amoxicillin when both a bacterial and a viral pathogen were isolated (combined infection; n = 198).ConclusionsAmoxicillin may reduce the risk of illness deterioration in patients with a combined bacterial and viral infection. We found no clinically meaningful benefit from amoxicillin treatment in other subgroups.     

雷尼替丁三联疗法对幽门螺杆菌阳性十二指肠溃疡的近期及远期疗效

对82例幽门螺杆菌(HP)阳性的十二指肠溃疡用雷尼替丁、羟氨苄青霉素和甲硝唑三联疗法2周,追踪1年,并与145例铋剂三联疗法病例对照。结果治疗组溃疡愈合率87.8%,HP根除率89.0%;对照组两参数为92.4%和85.7%(P均＞0.05)。治疗组副反应显著少。追踪1年,治疗组HP感染再燃9例(12.3%),重感染2例(2.7%),溃疡复发率HP阴转组1/61(1.6%),HP阳性组7/11(63.6%)(P＜0.01)。因再燃率高且在停药后4~8周发生,建议修定HP根除的标准时间,应从4周末延到8周末。     

Resistance of Helicobacter pylori to antibiotics from 2000 to 2009 in Shanghai

AIM: To investigate the resistance of Helicobacter pylori (H. pylori ) to 6 commonly used antibiotics from 2000 to 2009 in Shanghai. METHODS: A total of 293 H. pylori strains were collected from 2000 to 2009 in Shanghai and tested for their susceptibility to metronidazole, clarithromycin, amoxicillin, furazolidone, levofloxacin and tetracycline using agar dilution. RESULTS: The resistant rates of H. pylori to clarithromycin (8.6%, 9.0% and 20.7%) and levofloxacin (10.3%, 24.0% and 32.5%) increased from 2000...     

健胃愈疡胶囊联合“三联疗法”治疗幽门螺杆菌阳性老年人消化性溃疡

目的 探讨健胃愈疡胶囊治疗幽门螺杆菌(Hp)阳性老年人消化性溃疡的效果.方法 选取80例Hp阳性,年龄在60岁以上的消化性溃疡患者,随机分为两组.治疗组给予中药健胃愈疡胶囊和“三联疗法”(奥美拉唑,阿莫西林,甲硝唑);对照组仅给予“三联疗法”,疗程均为4周.治疗结束后6周应用胃镜和活检染色对溃疡愈合率和Hp根除率进行分析,同时观察主要症状改善情况.结果 治疗组和对照组患者溃疡愈合率分别为75％(30/40)和50％(20/40),差异有统计学意义(x2=5.33,P＜0.05);患者Hp根除率分别为85％(34/40)和65％( 26/40),差异有统计学意义(x2=4.27,P＜0.05);治疗有效率分别为90％和68％,差异有统计学意义(x2=6.05,P＜0.05).结论 中药健胃愈疡胶囊联合“三联疗法”是一种比较理想的治疗Hp阳性老年消化性溃疡的治疗方案.     

胃溃疡90例临床观察

目的:探讨90例胃溃疡患者的临床疗效。方法:采用回顾性分析的方法,分析90例胃溃疡患者的临床资料,依据治疗方式不同分为观察组和对照组。结果:观察组临床症状改善明显优于对照组,观察组临床疗效明显高于对照组,两组比较差异有统计学意义(P<0.05)。结论:泮托拉唑+阿莫西林+枸橼酸铋钾治疗胃溃疡临床疗效明显,值得临床推广应用。     

阿莫西林对人HepG2细胞DNA有短暂损伤作用

目的 为了探讨阿莫西林对人HepG2细胞DNA是否有损伤作用.方法 培养的人HepG2细胞经不同浓度(2、10、50和250μmol/L)阿莫西林处理1h或经50μmol/L阿莫西林处理不同时间(20、40、60、120和180min)后,运用单细胞凝胶电泳(SCGE)技术结合彗星图像软件(CASP)分析细胞尾部DNA百分率(tail DNA%)变化情况.结果 不同浓度阿莫西林处理后结果显示,HepG2细胞尾部DNA百分率明显升高,至50μmol/L阿莫西林时达到最高值,各浓度处理组与不处理对照组相比差异皆有显著性(P<0.01);而同一浓度(50μmol/L)阿莫西林处理不同时间后结果显示,HepG2细胞尾部DNA百分率逐渐升高,至1h处理时间点时达到最高值,其后随着处理时间延长HepG2细胞尾部DNA百分率逐渐降低.结论 阿莫西林对人HepG2细胞DNA有短暂损伤作用,阿莫西林诱发的HepG2细胞DNA损伤可能随时间延长逐渐被HepG2细胞本身修复除去.     

埃索美拉唑等联合治疗消化性溃疡的临床观察

目的 评价埃索美拉唑、阿莫西林、克拉霉素联合治疗消化性溃疡的临床疗效.方法将符合条件的143例患者随机分为A组（埃索美拉唑、阿莫西林、克拉霉素）和B组（奥美拉唑、阿莫西林、克拉霉素）,治疗1周后,A组以埃索美拉唑20 mg Bid,B组以奥美拉唑20 mg Bid维持治疗6周~7周.3个月后复查胃镜及14C-尿素呼气试验,观察2组溃疡愈合率及幽门螺杆菌（Hp）根治率.结果 A组和B组Hp根治率分别为92.59%和87.10%,2组比较无统计学差异（P〉0.05）.A组和B组溃疡愈合率分别为93.83%和90.23%,疼痛缓解率在3 d内A组明显高于B组,7 d后2组无显著差异.结论埃索美拉唑三联疗法能有效地清除幽门螺杆菌及提高溃疡愈合率,是一种可根治、有高效、副作用少的治疗方案,值得临床推广应用.     

阿莫西林克拉维酸钾不同给药方法治疗慢性支气管炎急性发作的临床疗效对比研究

目的对比并探讨阿莫西林克拉维酸钾序贯疗法和静脉滴注2种不同给药方法治疗慢性支气管炎急性发作的临床疗效。方法将88例慢性支气管炎急性发作患者随机分为观察组和对照组各44例。观察组采用阿莫西林克拉维酸钾序贯疗法给药方案治疗,对照组采用阿莫西林克拉维酸钾静脉滴注给药方案治疗。对2组临床疗效、不良反应发生情况及平均住院时间进行比较。结果观察组临床总有效率为88.64%,对照组为86.36%,2组比较差异无统计学意义(P>0.05)。观察组不良反应发生率为4.55%,低于对照组的13.64%;观察组平均住院时间为(4.27±2.15)d,短于对照组的(11.12±2.43)d,差异均有统计学意义(P<0.05)。结论阿莫西林克拉维酸钾序贯疗法治疗慢性支气管炎急性发作,具有安全、有效、经济实用的优点,值得临床推广应用。