含替硝唑序贯疗法根除幽门螺杆菌62例

目的: 观察由泮托拉唑、替硝唑、阿莫西林、克拉霉素组成的10日序贯疗法根除幽门螺杆菌( H pylori)的疗效.方法: 将经胃镜检查确诊为慢性胃炎和消化性溃疡且H pylori阳性的患者120例随机分为两组, 治疗组(62例)方案为前5 d给予泮托拉唑+阿莫西林, 后5 d给予泮托拉唑+克拉霉素+替硝唑;对照组(58例)三联疗法为泮托拉唑+阿莫西林+克拉霉素, 疗程7 d. 比较治疗后两组患者H pylori根除率.结果: 治疗组和对照组H pylori ITT根除率分别为83.87%和67.24%, PP根除率分别为89.66%和72.22%, 两组分别有统计学意义( P<0.05).结论: 含替硝唑的10日序贯疗法治疗H pylori感染具有较高的根除率.     

不同疗程伴同疗法与含铋剂四联疗法根除幽门螺杆菌的疗效

目的:观察不同疗程的伴同疗法与含铋剂四联疗法根除幽门螺杆菌(Helicobacter pylori,H.pylori)的疗效和安全性.方法:随机选取2014-07-01/2015-07-01郑州大学第一附属医院消化内科门诊就诊,行胃镜检查明确胃部疾病(慢性糜烂性胃炎或消化性溃疡)并行13C呼气试验检测阳性的282例患者,按照就诊顺序,分别采用4组治疗方案:A组:埃索美拉唑镁肠溶片20 mg bid+克拉霉素片500 mg bid+阿莫西林胶囊1000 mg bid+甲硝唑片400 mg bid,7 d;B组:埃索美拉唑镁肠溶片20 mg bid+克拉霉素片500 mg bid+阿莫西林胶囊1000 mg bid+枸橼酸铋钾胶囊220 mg bid,7 d;C组:埃索美拉唑镁肠溶片20 mg bid+克拉霉素片500 mg bid+阿莫西林胶囊1000 mg bid+甲硝唑片400 mg bid,14 d;D组:埃索美拉唑镁肠溶片20 mg bid+克拉霉素片500 mg bid+阿莫西林胶囊1000mg bid+枸橼酸铋钾胶囊220 mg bid,14 d.根除治疗结束后4 wk复查13C呼气试验.结果:本研究共纳入患者282例,按符合方案(per-protocol,PP)分析A组H.pylori根除率为84.06%,B组为83.33%,C组为94.12%,D组为97.91%;按意向性(intention to treat,ITT)分析A组为80.56%,B组为78.57%,C组为92.96%,D组为91.55%,其中A组与B组、C组与D组的H.pylori根除率,经PP分析及ITT分析差异均无统计学意义;A组与C组、B组与D组的H.pylori根除率,经PP分析及ITT分析差异均有统计学意义(P0.05);各组不良反应发生率及症状缓解率差异均无统计学意义.结论:伴同疗法和含铋剂四联疗法2 wk方案H.pylori根除率高、安全性良好且症状缓解率高,可推荐为临床根除H.pylori的一线治疗方案.     

四联疗法与序贯疗法治疗幽门螺杆菌根除失败患者的疗效分析

目的探讨四联疗法与序贯疗法对首次幽门螺杆菌(Helicobacter pylori,H.pylori)根除失败患者的补救治疗的疗效。方法将79例首次H.pylori根除失败患者随机分成2组,A组39例,用序贯方案(前5 d:泮托拉唑+左氧氟沙星,后5 d:泮托拉唑+克拉霉素+替硝唑),B组40例,用四联方案(泮托拉唑+胶体果胶铋+阿莫西林+克拉霉素),A、B两组疗程均为10 d。停药4周后复查14C-尿素呼气试验判断H.pylori根除情况。结果 79例患者中,共75例完成抗根除H.pylori治疗周期及随访。按意向性分析(ITT分析),两组H.pylori感染根除率分别为66.67%、70.00%;按符合方案集分析(PP分析),两组H.pylori感染根除率分别为70.27%、73.68%,差异均无统计学意义(P0.05)。两组不良反应发生率分别为15.4%、10.0%,差异无统计学意义(P0.05)。A组药品成本低于B组药品成本。结论四联疗法(10 d)及含左氧氟沙星的序贯疗法(10 d)均能有效补救首次根除治疗失败的H.pylori感染,而不良反应均不明显,但从药物经济学角度讲,序贯疗法药品成本优于四联疗法药品成本,10 d序贯疗法更适合推广使用。     

序贯疗法补救根除幽门螺杆菌感染的疗效观察

目的比较序贯疗法与传统四联疗法对幽门螺杆菌(H.pylori)根除失败后补救治疗的临床疗效。方法选取胃镜下H.pylori快速尿素酶试验或14C尿素呼气试验阳性的患者,经我国标准H.pylori一线三联根除方案治疗7天,停药4周后检测H.pylori,结果仍为阳性者判定为H.pylori根治失败,即进行H.pylori的补救根除治疗,共68例患者入选。随机分为两组:治疗组予以序贯疗法:前5天口服埃索美拉唑20mg和阿莫西林1000mg,2次/d,后5天口服埃索美拉唑20mg、克拉霉素500mg和甲硝唑400mg,2次/d;对照组予以传统四联疗法:口服埃索美拉唑20mg、阿莫西林1000mg、呋喃唑酮100mg和胶体果胶铋100mg,2次/d,疗程7天。疗程结束后4周行14C尿素呼气试验检测H.pylori。结果疗程结束后4周,治疗组H.pylori根除率为93.9%,对照组H.pylori根除率为73.3%,两组H.pylori根除率比较有显著性差异(P0.05)。结论序贯疗法对H.pylori的根除率高于传统四联疗法,可作为有效的H.pylori补救根除治疗方案。     

以泮托拉唑为基础的三联和四联疗法根除幽门螺杆菌疗效比较——一项单中心、随机、开放、平行对照研究

背景：近年质子泵抑制剂（PPI）＋阿莫西林＋克拉霉素标准三联疗法对幽门螺杆菌（H.pylori）的根除率有所降低,PPI＋铋剂＋甲硝唑＋四环素的四联疗法能否成为一线治疗的首选以及适当延长疗程能否提高根除率尚有待明确。目的：比较以泮托拉唑为基础的7d标准三联疗法与7d、10d四联疗法根除H.pylori的疗效。方法：133例非溃疡性消化不良的H.pylori感染患者随机分配至7d三联组（45例,泮托拉唑40mgbid＋阿莫西林1.0gbid＋克拉霉素500mgbid,PAC方案）以及7d、10d四联组（43例和45例,泮托拉唑40mgbid＋枸橼酸铋钾220mgbid＋甲硝唑400mgtid＋四环素750mgbid,PBMT方案）。治疗结束后至少间隔4周行13C-尿素呼气试验复查H.pylori,评估治疗结果。结果：共129例患者按方案完成治疗。三组H.pylori根除率按意图治疗（ITT）分析分别为73.3%、79.1%和88.9%,按方案（PP）分析分别为75.0%、82.9%和90.9%。7dPAC方案的PP根除率显著低于10dPBMT方案（P〈0.05）。除四联组中有2例患者分别因头晕和腹泻而未完成治疗外,其余患者的不良反应相似且均能耐受。结论：在7d标准三联疗法H.pylori根除疗效降低的情况下,含泮托拉唑、铋剂、甲硝唑和四环素的10d四联疗法可考虑作为根除治疗的首选方案。     

10d序贯疗法对根除幽门螺杆菌疗效的随访研究

背景:幽门螺杆菌(H.pylori)与慢性胃炎、消化性溃疡、胃癌和胃黏膜相关淋巴组织(MALT)淋巴瘤密切相关,但标准三联疗法的根除率逐年下降。目的:比较10 d序贯疗法和三联疗法根除H.pylori的疗效。方法:将经快速尿素酶试验(RUT)和~(14)C-尿素呼气试验(UBT)证实为H.pylori阳性的106例消化性溃疡、慢性糜烂性胃炎和萎缩性胃炎患者随机分为以雷贝拉唑为基础的10 d序贯疗法组(n=56)和三联疗法组(n=50)。治疗结束4周后复查RUT和,~(14)C-UBT,评估H.pylori根除情况;随访1年后再复查~(14)C-UBT评估H.pylori复发情况。结果:共93例患者按方案完成治疗。10 d序贯疗法组H.pylori根除率按意向治疗(ITT)和按方案(PP)分析均显著高于三联疗法组(ITF:89.3%对62.0%,P0.01;PP:94.3%对77.5%,P0.05);10 d序贯疗法组不良反应发生率(7.1%对30.0%,P0.01)和随访1年后的H.pylori复发率(6.0%对25.8%,P0.01)均显著低于三联疗法组。结论:以雷贝拉唑为基础的10 d序贯疗法可明显提高H.pylori根除率,提高患者的依从性,减少不良反应的发生。     

序贯疗法与含左氧氟沙星四联疗法在首次根除幽门螺杆菌失败后补救治疗的疗效比较

目的:观察对比序贯疗法及含左氧氟沙星的四联疗法对首次根除幽门螺杆菌(Helicobacter pylori,H.pylori)失败患者行补救根除时的疗效.方法:自2010-09/2014-05共收集首次根除失败的H.pylori感染患者167例.随机分为2组,序贯治疗组共85例,四联治疗组82例.序贯治疗方法为:前5天予以雷贝拉唑10 mg,2次/d;阿莫西林胶囊1000 mg,2次/d;后5天予以雷贝拉唑10 mg,口服2次/d;克拉霉素分散片500 mg,2次/d;奥硝唑片0.5 g,2次/d.四联治疗方法为:雷贝拉唑10 mg,2次/d;枸橼酸铋钾胶囊300 mg2次/d;左氧氟沙星片0.2 g,2次/d;阿莫西林1000 mg,2次/d.四联药物共服药12 d.观察患者在治疗期间的药物不良反应.结果:治疗结束后1 mo复查14C呼气试验,共有152例患者随访成功.序贯治疗组有77例随访成功,60例为阴性,符合方案集(per-protocol P P)分析根除率为77.92%,意向性治疗原则(intention-to-treat,ITT)分析根除率为70.6%四联治疗组随访成功的75例,有3例发生严重不良反应而退出试验.72中有61例为阴性,PP分析根除率为84.72%,ITT分析根除率为74.4%.两组PP分析根除率及ITT根除率均无统计学差异(60/77与61/72,χ2=1.127,P=0.288;60/85与61/82,χ2=0.302,P=0.582).序贯治疗组随访的77例共有9例出现不良反应不良反应发生率为11.7%.四联治疗组随访的75例中,有11例发生不良反应,不良反应发生率分别为14.7%.两组不良反应发生率差异无统计学意义(χ2=0.295,P=0.587).结论:四联疗法及序贯疗法在对于首次H.pylori根除失败后再根除时的疗效无显著性差异.不推荐将两种疗法作为H.pylori的补救根治首选方案.     

大剂量阿莫西林/埃索美拉唑二联方案根除幽门螺杆菌

目的评估大剂量阿莫西林/埃索美拉唑二联方案在幽门螺杆菌(Helicobacter pylori,H.pylori)感染初次治疗患者中的疗效及安全性.方法 142例H.pylori感染的初次治疗患者随机进入大剂量阿莫西林/埃索美拉唑二联方案(EA)组(埃索美拉唑20 mg qid+阿莫西林0.75g qid,疗程14d)和铋剂四联方案(EBAC)组(埃索美拉唑20mg bid+枸橼酸铋钾220 mg bid+阿莫西林1.0g bid+克拉霉素0.5g bid,疗程14d),治疗结束后6wk复查尿素呼气试验,判断H.pylori根除疗效.结果共131例患者完成研究,EA组按意向治疗(intentionto-treat,ITT)与按方案(per-protocol,PP)分析H.pylori根除率分别为82.9%和89.2%,EBAC组分别为86.1%和93.9%,两组根除率的ITT、PP分析差异均无统计学意义(P0.05).按PP分析,EBAC组不良反应发生率明显高于EA组(15.2%vs 3.1%,P0.05).结论大剂量阿莫西林/埃索美拉唑二联方案可作为安全、有效的H.pylori感染初次治疗方案.     

8d与10d序贯疗法根除幽门螺杆菌的疗效比较

目的:比较雷贝拉唑、阿莫西林、克拉霉素、奥硝唑组成的8d与10d序贯疗法根除幽门螺杆菌(H.pylori)的疗效.方法:将经胃镜检查确诊为慢性胃炎和消化性溃疡,且H.pylori阳性的217例患者随机分为2组,8d组(n=104)方案:前4d,雷贝拉唑+阿莫西林;后4d,雷贝拉唑+克拉霉素+奥硝唑.10d组(n=113)方案:前5d,雷贝拉唑+阿莫西林;后5d,雷贝拉唑+克拉霉素+奥硝唑.根除治疗后复查14C-尿素呼气试验,比较两组H.pylori根除率.结果:8d组和10d组H.pyloriITT根除率分别为89.3%和91.2%,PP根除率分别为92.0%和93.7%.两种分析方法比较两组的根除率差异均无统计学意义(P>0.05),但8d序贯疗法降低了成本-效果比,减轻了患者的经济负担.两种方案症状缓解率及不良反应发生率的差异无统计学意义(P>0.05).结论:8d序贯疗法可以获得较高的H.pylori根除率和症状缓解率,且经济、安全,是一种可供选择的一线治疗方案.     

序贯疗法和标准三联疗法根除幽门螺杆菌的疗效比较

目的:观察10d序贯疗法治疗幽门螺杆菌(Helicobacter pylori,H.pylori)的疗效及不良反应,与14d三联标准疗法比较H.pylori根除情况及经济学上有无优越性.方法:将103例经胃镜检查确诊为慢性胃炎或消化性溃疡且H.pylori阳性的患者随机分为两组,治疗组(10d序贯疗法)52例,前5d埃索美拉唑、阿莫西林,后5d埃索美拉唑、克拉霉素、替硝唑.对照组(14d标准三联疗法)51例,埃索美拉唑、阿莫西林、克拉霉素14d.所有患者停药4wk后复查13C呼气试验或胃镜检查,判断H.pylori根除情况.结果:治疗组H.pylori根除率为90.4%,与对照组(90.2%)比较无统计学差异(P=1.000);两组不良反应发生率分别为12/52(23.1%)、18/51(35.3%),两组比较无统计学差异(P=0.172);治疗组费用为380.6元,较对照组(677.88元)明显减低.结论:10d序贯疗法的H.pylori根除率不低于标准14d三联疗法,2组不良反应发生率相似,但10d序贯疗法根除H.pylori的效价比更高.     

Efficacy of Different Helicobacter pylori Eradication Regimens in Patients Affected by Insulin-Dependent Diabetes Mellitus

Background: Patients with insulin-dependent diabetes mellitus (IDDM) are often affected by chronic infections; antibiotic absorption, however, may be influenced by the disease. H. pylori eradication appears to be reduced in IDDM patients. The aim of the study was to evaluate the efficacy of the most common H. pylori eradication regimens in a population of IDDM-infected patients. Methods: One hundred and seventy-two IDDM patients were evaluated. H. pylori infection was assessed through the 13C-urea breath test. Infected patients were randomly assigned to three different standard 7-day eradication regimens: 1) amoxicillin, clarithromycin, pantoprazole; 2) tinidazole, clarithromycin, ranitidine bismuth citrate; or 3) tinidazole, clarithromycin, pantoprazole. Patients in whom eradication was not successful in the first cycle were subsequently submitted to a 7-day therapy with tinidazole, tetracycline, bismuth, and pantoprazole. Results: Thirty-seven per cent of IDDM patients were infected. None of the triple therapies used provided an eradication higher than 62%. Conversely, the quadruple regimen was successful in 88% of the patients. Ten per cent of the subjects undergoing the triple therapies showed minor side effects, without significant differences among groups, whereas side effects occurred in 25% of the patients treated with the quadruple therapy (P &lt; 0.05). Conclusions: IDDM patients show a low H. pylori eradication rate with a standard triple therapy regardless of the regimen utilized, the dosage and/or the duration of the therapy used appearing not to be sufficient to eradicate the infection efficiently. The use of a quadruple regimen leads to the cure of a large percentage of the infected patients in whom the eradication was unsuccessful in the first therapy, although it is accompanied by a greater incidence of minor side effects.     

评估以泮托拉唑为基础的三联和四联疗法根除幽门螺杆菌的疗效

目的 比较以泮托拉唑为基础的7d标准三联疗法与泮托拉唑+铋剂+甲硝唑+四环素的10 d四联疗法根除Hp的疗效和安全性.方法 170例非溃疡性消化不良的Hp感染者随机入选三联、四联治疗组.三联治疗组实行PAC方案:泮托拉唑40 mg(2次/d)+阿莫西林1.0 g(2次/d)+克拉霉素500 mg(2次/d),口服7 d.四联治疗组实行PBMT方案:泮托拉唑40 mg(2次/d)+胶体次枸橼酸铋220 mg(2次/d)+四环素750 mg(2次/d)+甲硝唑400 mg(2次/d),口服10 d.治疗结束后至少停药4周后复查13C-尿素呼气试验,结果≤4%.为Hp阴性,表示根除成功.同时评估疗效及安全性.结果 166例患者按方案完成治疗.三联治疗组按意图治疗分析(ITT)根除率为63.53%(54/85),较四联治疗组低[89.41%(76/85),x2=17.168,P=0.000].三联治疗组按实验方案分析(PP)根除率为65.06%(54/83),亦较四联治疗组低[91.57%(76/83),x2=13.588,P=0.000].从年龄段分析,年龄＞30岁者三联治疗组根除失败率为22.22%(4/18),较四联治疗组高[3.84%(1/26),x2=19.884,P=0.000].三联和四联治疗组不良反应发生率分别为60.00%(51/85)和42.35%(36/85).结论 在7 d标准三联疗法Hp根除疗效降低的情况下,含泮托拉唑、铋剂、四环素和甲硝唑的10 d四联方案可考虑为首选方案.

Abstract：

Objective Compare the efficacy and safety of pantoprazole-based 7-day standard triple therapy with 10-day quadruple therapy including pantoprazole, bismuth, metronidazole and tetracycline in Helicobacter pylori (H.pylori) eradication.Methods A total of 170 H.pylori positive patients with non-ulcer dyspepsia were recruited and randomly assigned into triple and quadruple therapy groups.The triple therapy group was implemented with PAC program which included orally taking pantoprazole 40 mg twice per day, amoxicillin 1.0 g twice per day and clarithromycin 500 mg twice per day for seven days.The quadruple therapy group was implemented with PBMT program which consisted of orally taking pantoprazole 40 mg twice per day, colloidal bismuth subcitrate 220 mg twice per day, metronidazole 400 mg three times per day and tetracycline 750 mg twice per day for ten days.The 13C -urea breathe test was re-examined at least 4 weeks after the completion of treatment, the result lower than 4%.was H.pylori negative which indicated the success of H.pylori eradication.The efficacy and safety were also evaluated.Results A total of 166 patients completed the treatment.With intention-to-treat (ITT) analysis, the H.pylori eradication rate in the triple therapy group was 63.5% (54/85), lower than that of the quadruple therapy group (89.41%(76/85) ,x2= 17.168,P=0.000).With per protocol (PP) analysis, the eradication rate in the triple therapy group was 65.06% (54/83), also lower than that of the quadruple therapy group (91.57 % (76/83) ,x2 = 13.588 ,P=0.000).Through the age analysis, in patients over 30 years old,the eradication failed rate in the triple therapy group was 22.22% (4/18), higher than that of the quadruple therapy group (3.84% (1 / 26), x2 = 19.884, P=0.000).The incidence of adverse reaction rates of the triple and quadruple therapy group were 60.00% (51/85) and 42.35 % (36/85) respectively.Conclusion Since the reduction of eradication rate with seven day standard triple therapy,the 10-day pantoprazole, bismuth, metronidazole and tetracycline quadruple therapy may be considered as the first choice.     

A randomized trial comparing seven-day ranitidine bismuth citrate and clarithromycin dual therapy to seven-day omeprazole, clarithromycin and amoxicillin triple therapy for the eradication of Helicobacter pylori.

OBJECTIVE: To assess Helicobacter pylori eradication after one week dual ranitidine bismuth citrate-clarithromycin (RBC-C) or triple omeprazole, clarithromycin and amoxicillin (OCA) therapy. METHODS: In this multicentre Canadian trial, H pylori-positive patients with functional dyspepsia or inactive peptic ulcer disease were randomized to open-label treatment with RBC-C (ranitidine bismuth citrate 400 mg plus clarithromycin 500 mg) or OCA (omezaprole 20 mg, clarithromycin 500 mg and amoxicillin 1000 mg), given twice a day for seven days. Treatment allocation was randomly assigned. H pylori infection was confirmed by positive 13C-urea breath test (13C-UBT). H pylori status was reassessed by UBT at least four and 12 weeks after treatment (negative: d13CO2 below 3.5 per mil). Intention-to-treat (ITT) eradication rates were determined for all patients with confirmed H pylori infection. Per protocol (PP) rate was determined for all patients treated with at least two evaluable follow-up visits. RESULTS: Three hundred five patients were included in the ITT and 222 in the PP analysis. The ITT eradication rates were 66% for RBC-C and 78% for OCA. The PP success rates were 84% for RBC-C and 96% for OCA. The difference for both ITT 12% (95% CI 2 to 22) and PP 12% (95% CI 4 to 19) were statistically significant, P=0.030 and P=0.007, respectively. Treatment was generally well tolerated. CONCLUSION: The eradication rate for the seven-day dual RBC-C regimen was lower than that for OCA.     

含铋剂和克拉霉素的四联根除方案在幽门螺杆菌一线治疗中的作用

背景：近年经典三联方案对幽门螺杆菌（H.pylori）感染的根除疗效明显下降,建立新型、安全和高效的一线标准治疗方案是临床工作的当务之急。目的：评估含铋剂和克拉霉素的四联方案作为H.pylori一线治疗方案的疗效和安全性。方法：120例胃镜诊断为非溃疡性消化不良的H.pylori感染患者随机分为3组：7 d三联组（奥美拉唑20 mgbid＋阿莫西林1000 mg bid＋克拉霉素500 mg bid,疗程7 d）、7 d四联组（7 d三联方案＋枸橼酸铋钾220 mg bid,疗程7 d）和2周四联组（方案同7 d四联组,疗程2周）。治疗结束后至少4周行13C-尿素呼气试验以评估根除疗效。H.pylori分离菌株行克拉霉素、甲硝唑和阿莫西林药敏试验。结果：115例患者按方案完成治疗。7 d三联组、7 d四联组和2周四联组按意向治疗（ITT）分析H.pylori根除率分别为70.0%、75.0%和90.0%,按方案（PP）分析分别为73.7%、76.9%和94.7%。2周四联组ITT和PP根除率均显著高于7 d三联组（P〈0.05）,PP根除率显著高于7 d四联组（P=0.026）,而7 d三联组ITT和PP根除率与7 d四联组相比均无明显差异。H.pylori对克拉霉素、甲硝唑和阿莫西林的耐药率分别为24.2%、48.3%和0%,7 d三联组、7 d四联组和2周四联组对克拉霉素耐药菌株的根除率逐渐升高（37.5%、55.6%、80.0%）,但差异无统计学意义。除2周四联组中1例患者因皮肤过敏而未完成治疗外,其余患者的不良反应相似且轻微,耐受性良好。结论：含铋剂和克拉霉素的2周四联方案可明显提高H.pylori根除疗效,且安全性较高,可作为H.pylori一线治疗的标准方案。     

Evaluation of triple and quadruple Helicobacter pylori eradication therapies in Iranian children: a randomized clinical trial

BACKGROUND: Clinical trials in children concerning Helicobacter pylori eradication treatments are scarce. The purpose of this study was to assess the efficacy of proton pump inhibitor (PPI)-based triple therapy using PPI, amoxicillin and clarithromycin in Iranian children. We also evaluated the efficacy of quadruple therapy with PPI, metronidazole, amoxicilin and bismuth citrate in Iranian children. METHODS: This was a randomized clinical trial performed in Emam Khomeini Hospital between 2003 and 2004. Patients with confirmed H. pylori infection by histology were divided into two groups in a randomized 1:1 scheme: the triple regimen group (omeprazole, clarithromycin and amoxicillin for 10 days) and the quadruple regimen group (omeprazole, amoxicillin, metronidazole and bismuth citrate for 10 days). The eradication was assessed by the C-urea breath test 4 weeks after the end of treatment and analyzed by per-protocol and intention-to-treat approaches. RESULTS: One hundred and twenty-two patients (mean age 12.36+/-3.06 years) were entered into the study. Only 100 patients completed the study (50 patients in each regimen group). The eradication rates by triple therapy were 92% and 75.5% for the "per-protocol" and "intention-to-treat" approaches, respectively. In the quadruple regimen group, the eradication rates were 84% by the per-protocol approach and 68.8% in the intention-to-treat approach. Symptom responses to therapy were reported in all patients with successful eradication (88% of all patients). CONCLUSION: With regard to recent recommendations, we also suggest PPI, amoxicillin and clarithromycin triple therapy as a first-line eradication treatment, and quadruple therapies as a second-line option, in Iranian children.     

Recent success of pantoprazole -or lansoprazole- based clarithromycin plus amoxicillin treatment in the eradication of Helicobacter pylori.

BACKGROUND/AIMS: There are some reports showing that resistance of Helicobacter pylori (H. pylori) to clarithromycin has increased in recent years. We aimed to investigate the current success of a most popular first-line eradication regimen by using two different proton pump inhibitors: lansoprazole and pantoprazole. METHODS: Ninety patients with H. pylori-positive functional dyspepsia were randomized to receive pantoprazole 40 mg b.i.d. or lansoprazole 30 mg b.i.d. in addition to amoxicillin 1,000 mg and clarithromycin 500 mg twice daily for 14 days in a multicenter study. H. pylori infection was determined by histological examination and a rapid urease test. A follow-up endoscopy was performed to assess the H. pylori eradication six weeks after the end of therapy. RESULTS: Seventy-nine patients completed the study protocol properly. The H. pylori eradication rates according to per protocol analysis were 70% in group pantoprazole, amoxicillin and clarithromycin (28/40) and 69.2% in group pantoprazole, amoxicillin and clarithromycin (27/39). The eradication rates according to intention to treat analysis were 62.2% and 60% in lansoprazole, amoxicillin, clarithromycin, pantoprazole, amoxicillin, clarithromycin groups, respectively. The eradication rates were similar in both protocols (p>0.05). CONCLUSIONS: The most popular first-line eradication protocols of H. pylori achieved only a moderate success in the current study. Alternative therapy options are needed instead of clarithromycin-based triple treatment for eradication of H. pylori. The choice of proton pump inhibitor is not important in the eradication rate of H. pylori.     

序贯疗法与标准四联疗法对幽门螺杆菌根除失败后补救治疗的疗效分析

近年经典三联疗法的幽门螺杆菌（11．pylori）根除疗效明显降低,选择有效补救疗法对Hpylori根除失败者有重要意义。目的：比较序贯疗法与标准四联疗法对且pylori根除失败者的疗效。方法：将98例Hpylori根除失败者随机分为序贯疗法组（前5d予奥美拉唑20mg＋阿莫西林1000mgbid,后5d予奥美拉唑20mg＋左氧氟沙星200mg＋克拉霉素500mgbid）和标准四联疗法组（予奥美拉唑20mg＋胶体次枸橼酸铋钾220mg＋阿莫西林1000mg＋克拉霉素500mgbid,疗程7d）。停药4周后复查”C一尿素呼气试验,评估Hpylori根除疗效。结果：共95例患者完成方案,序贯疗法组11Tr和PP分析的Hpylori根除率均显著高于标准四联疗法组（ITF：89．8％对71,4％,PP：91．7％对74。5％,P〈0．05）,序贯疗法组临床症状改善的总有效率亦显著高于标准四联疗法组（95．8％对80．9％,P〈0．05）,两组不良反应发生率无明显差异（P〉0．05）。结论：对Hpylori根除治疗失败的患者,序贯疗法和标准四联疗法均可作为有效的补救治疗方案,但10d序贯疗法的疗效优于7d标准四联疗法。     

Efficacy of different Helicobacter pylori eradication regimens in patients affected by insulin-dependent diabetes mellitus

BACKGROUND: Patients with insulin-dependent diabetes mellitus (IDDM) are often affected by chronic infections; antibiotic absorption, however, may be influenced by the disease. H. pylori eradication appears to be reduced in IDDM patients. The aim of the study was to evaluate the efficacy of the most common H. pylori eradication regimens in a population of IDDM-infected patients. METHODS: One hundred and seventy-two IDDM patients were evaluated. H. pylori infection was assessed through the 13C-urea breath test. Infected patients were randomly assigned to three different standard 7-day eradication regimens: 1) amoxicillin, clarithromycin, pantoprazole; 2) tinidazole, clarithromycin, ranitidine bismuth citrate; or 3) tinidazole, clarithromycin, pantoprazole. Patients in whom eradication was not successful in the first cycle were subsequently submitted to a 7-day therapy with tinidazole, tetracycline, bismuth, and pantoprazole. RESULTS: Thirty-seven per cent of IDDM patients were infected. None of the triple therapies used provided an eradication higher than 62%. Conversely, the quadruple regimen was successful in 88% of the patients. Ten per cent of the subjects undergoing the triple therapies showed minor side effects, without significant differences among groups, whereas side effects occurred in 25% of the patients treated with the quadruple therapy (P < 0.05). CONCLUSIONS: IDDM patients show a low H. pylori eradication rate with a standard triple therapy regardless of the regimen utilized, the dosage and/or the duration of the therapy used appearing not to be sufficient to eradicate the infection efficiently. The use of a quadruple regimen leads to the cure of a large percentage of the infected patients in whom the eradication was unsuccessful in the first therapy, although it is accompanied by a greater incidence of minor side effects.     

A 10-day levofloxacin-based therapy in patients with resistant Helicobacter pylori infection: a controlled trial.

BACKGROUND & AIMS: Antibiotic resistance is a major issue in anti- Helicobacter pylori treatment. This study was aimed at assessing the efficacy of 2 therapies in patients with resistant H pylori infection. METHODS: Patients who had failed 1 or more eradication regimens underwent upper gastrointestinal endoscopy and 2 antral and 2 corpus biopsy specimens were taken for histology and culture. Metronidazole, clarithromycin, and amoxicillin resistance were determined by E-test. Patients were randomly assigned to 2 therapies: 1 group received pantoprazole 40 mg, amoxicillin 1 g, levofloxacin 250 mg, all twice daily for 10 days, and the other group was treated with omeprazole 20 mg twice daily for the first week and omeprazole 20 mg twice daily, tetracycline 250 mg 4 times daily, metronidazole 500 mg twice daily, and bismuth subcitrate 240 mg twice daily for the second week. Therapeutic success was evaluated by 13C urea breath test after 4 weeks of treatment. RESULTS: We enrolled 44 patients in the levofloxacin-based regimen and 46 patients in the quadruple therapy. The former was successful in 31 of 44 (70%; 95% confidence interval: 53-87) and the latter in 17 of 46 (37%; 95% confidence interval: 23-47) patients, using intention-to-treat (ITT) analysis (P < .001). The rates of H pylori resistance to metronidazole, clarithromycin, and amoxicillin were 46%, 12%, and 0%, respectively. Resistance to both metronidazole and clarithromycin was found in 10% of cases. CONCLUSIONS: Triple therapy containing levofloxacin was better than quadruple therapy. The 70% success rate observed indicates that 10 days of pantoprazole, amoxicillin, and levofloxacin should be considered in patients who had failed 1 or more eradication regimens.