奥美拉唑、克拉霉素、阿莫西林三联疗法根除幽门螺杆菌

目的:比较奥美拉唑、克拉霉素、阿莫西林与奥美拉唑、甲硝唑、阿莫西林两种“三联疗法”对幽门螺杆菌(Hp)根除的疗效。方法:10 3例Hp阳性的消化性溃疡患者随机分为2组:A组5 8例,以奥美拉唑2 0mg 克拉霉素5 0 0mg 阿莫西林10 0 0mg ,每天2次,疗程7天;B组4 5例,以奥美拉唑2 0mg 甲硝唑4 0 0mg 阿莫西林10 0 0mg ,每天2次,疗程7天。活动期溃疡患者抗Hp治疗后继续服用奥美拉唑2 0mg ,每天一次,疗程(2～4 )周。抗Hp治疗结束2个月后复查胃镜并检测Hp。结果:A、B两组的根除率分别为89.3%和84 .1% ;活动期溃疡愈合率分别为96 .7%和10 0 % ;副反应发生率分别为10 .3%和11.1% ;两组间差别无显著性,P >0 .0 5。结论:克拉霉素或甲硝唑与质子泵抑制剂(PPI)、阿莫西林组成的两种“三联疗法”疗效相当,而甲硝唑因价廉、安全在临床上更为实用。

Triple Therapy with Omeprazole, Clarithromycin and Amoxyicillin for Eradication of Helicobacter Pylori Infection

Objective: One-week triple therapy with proton pump inhibitor (PPI), clarithromycin and amoxicillin has recently been proposed as first-line treatment for Helicobacter pylori(Hp) infection, however, data regarding the effects of this regimen in China is scarce. The aim of this prospective study was to compare the efficacy of clarithromycin 500mg vs. metroniazole 400mg twice daily (bid)in combination with omeprazole and amoxicillin for the eradication of Hp.Methods:A total of 103 subjects with Hp -associated peptic ulcer were randomly divided into two groups of I-week triple therapy with omprazole 20 mg bid, amoxicillin 1 000 mg bid and either clarithromycin 500 mg bid (group A,n=58)or metronidazole 400 mg bid (group B, n=45).The patients of active peptic ulcer were continued to treat with omeprazole 20mg/day for 2 to 4 weeks after anti-Hp therapy . Endoscopic examination with four biopsies (two specimens from the antrum and two trom the gastric boby)was performed. The status of Hp infection was determined using rapid urease test and histology (modified Giemsa stain)of the biopsy specimens. Two months after anti-Hp therapy, endoscopy and gastric biopsies were repeated. Results:One hundred patients completed the entire course of therapy and returned for follow-up. The -Hp eradication rates in Groups A and B were 89.3% (50/56) and 84.1%(37/44)by intention-to-treat analysis and 86.2(50/58)and 82.2%(37/45)by per-protocol analysis, repectively (P>0.05). The active ulcer healing rate was 96.7%(29/30) in Group A and 100% (21/21) in Group B. Six patients in group A (10.3%) and five in group B (11.1%)reported adverse events (P> 0.05 ). Two patient in group A (33.3%)and one in group B(20%)discontinued the study because of these drug-related side-effects(P>0.05). Conclusions:One-week triple therapy with PPI and amoxicillin in combination with either clarithromycin or metronidazole is effected for the eradication of Hp.The therapeutic regimen comprising metronidazole with lower cost, good compliance and mild side-effects may offer a good choice for treatment of peptic ulcer associated with Hp infection in clinical practice.