枸橼酸铋雷尼替丁、阿莫西林和阿奇霉素三联疗法根除幽门螺杆菌感染68例疗效观察

幽门螺杆菌(Hp)感染后能导致胃炎和消化性溃疡病的发生,人类胃黏膜上的Hp持续存在可增加胃癌和胃淋巴瘤发生的危险,根除Hp是防治这些疾病的重要措施之一.枸橼酸铋雷尼替丁(RBC)与2种抗生素结合的三联疗法已被推荐为根除Hp治疗的一线方案.我们自2005年1月～2006年4月采用枸橼酸铋雷尼替丁 阿奇霉素 阿莫西林三联疗法治疗有Hp感染的消化性溃疡患者68例.现将结果 报道如下.     

胃复春联合三联疗法治疗幽门螺杆菌阳性胃溃疡临床观察

[目的]观察胃复春联合三联疗法（枸橼酸铋雷尼替丁片、阿莫西林分散片、克拉霉素缓释片）对幽门螺杆菌（Hp）阳性胃溃疡的临床疗效,及对Hp根除率、胃泌素（GAS）、胃动素（MTL）的影响.[方法]将Hp阳性的胃溃疡患者176例随机分为两组,治疗组92例、对照组84例.对照组使用三联疗法,治疗组在对照组基础上加服胃复春;服药10天后,对照组单独口服枸橼酸铋雷尼替丁片4周;治疗组在服用枸橼酸铋雷尼替丁片基础上加服胃复春片4周.观察两组的临床疗效、Hp根除率、胃泌素、胃动素水平.[结果]治疗组总有效率95.65 ％,优于对照组,差异有统计学意义（P＜0.05）;治疗组Hp根除率91.30％,优于对照组,差异有统计学意义（P＜0.05）;治疗组治疗后胃泌素水平低于治疗前水平,亦低于对照组治疗后水平,其差异均有统计学意义（P＜0.05）.[结论]胃复春联合三联疗法抗Hp治疗方案能有效根除幽门螺杆菌,降低胃泌素水平,对幽门螺杆菌阳性胃溃疡能起到较好的治疗效果.     

不同治疗方案根除幽门螺杆菌感染的疗效评价

目的 通过对两种不同方法 治疗幽门螺杆菌(Hp)感染患者的疗效进行观察,寻找根除Hp感染的最佳方案.方法 采用随机对照方法,将内科门诊就诊的120例Hp感染患者的资料随机分成两组,对照组60例使用传统四联疗法(雷贝拉唑+克拉霉素+甲硝唑+胶体次枸橼酸铋)治疗7 d;观察组60例给予四联疗法(雷贝拉唑+阿莫西林+左氧氟沙星+胶体次枸橼酸铋)治疗7 d.两组4周后均做13C尿素酶呼气试验,并做比较.结果 对照组Hp根除率为70.9%,观察组Hp根除率为92.9%,两组Hp根除率比较差异有统计学意义(P<0.05).结论 四联疗法(雷贝拉唑+阿莫西林+左氧氟沙星+胶体次枸橼酸铋)能更有效地根除Hp.     

铋剂四联疗法根治幽门螺杆菌的临床观察

幽门螺杆菌（Hp）是小儿及成人慢性胃炎和消化性溃疡等疾病的重要致病因素。随着药物的广泛使用而致Hp耐药率上升,常用的含质子泵抑制剂（PPI）的标准三联疗法（PPI＋克拉霉素＋阿莫西林或PPI＋克拉霉素＋甲硝唑）根除率有下降趋势,铋剂四联方案（铋剂＋PPI＋克拉霉素＋阿莫西林）越来越受重视。为此,本研究采用胶体果胶铋于混悬剂联合埃索美拉唑镁、阿莫西林、     

比较以阿莫西林和呋喃唑酮为基础的抗幽门螺杆菌四联和三联方案

目的比较以阿莫西林和呋喃唑酮为基础的四联、三联疗法根除幽门螺杆菌(H.pylori)的临床疗效。方法对符合条件的816例H.pylori阳性的慢性胃炎、十二指肠球部炎及消化性溃疡患者,根据治疗方案的随机选择分组如下:(1)质子泵抑制剂(PPI)+枸橼酸铋钾+阿莫西林+呋喃唑酮(含PPI四联组);(2)枸橼酸铋雷尼替丁(RBC)+阿莫西林+呋喃唑酮(含RBC三联组);(3)PPI+阿莫西林+呋喃唑酮(含PPI三联组);(4)枸橼酸铋钾+阿莫西林+呋喃唑酮(含枸橼酸铋钾三联组)。疗程结束4周后,复查快速尿素酶试验或13C呼气试验评判H.pylori根除情况。结果 (1)含PPI四联组与其他各组的H.pylori根除率比较均有显著性差异(P<0.05);(2)将上述每组患者按照接受H.pylori根除治疗的时间(2004年-2006年、2007年-2009年、2010年-2012年)分为3个时间段,在相同治疗方案下比较H.pylori根除率。结果显示同一治疗组的H.pylori根除率在不同时间段无显著差异(P>0.05)。结论含PPI四联疗法H.pylori根除率高,无与治疗相关的严重不良反应,在传统的一线含PPI三联疗法根除率H.pylori逐年下降的状况下,为克服原发耐药和避免继发耐药产生,值得进一步探讨作为根除H.pylori一线治疗选择方案的可能性。     

依卡倍特钠4联疗法根除幽门螺杆菌阳性慢性胃炎63例临床研究

目的 明确依卡倍特钠4联疗法根除幽门螺杆菌(Hp)的疗效和安全性.方法 采用完全随机对照的方法将124例Hp阳性慢性胃炎患者随机分配到治疗组和对照组.治疗组用依卡倍特钠颗粒+阿莫西林胶囊+克拉霉素+奥美拉唑肠溶胶囊,对照组用枸橼酸铋钾颗粒+阿莫西林胶囊+克拉霉素+奥美拉唑肠溶胶囊,疗程10天.统计两组患者Hp根除率、安全性及疗效.结果 治疗组Hp根除率高于对照组,两组比较差异有统计学意义(P＜0.05),不良反应发生率比较差异无统计学意义(P＞0.05).结论 依卡倍特钠4联疗法根除Hp阳性慢性胃炎患者疗效高,安全性好,值得临床推广.     

药敏试验指导根除幽门螺杆菌治疗的临床研究

目的 观察根据药敏结果选择两种敏感抗生素加奥美拉唑三联1周疗法治疗幽门螺杆菌(Hp)的根除率,探讨幽门螺杆菌药敏试验对根除幽门螺杆菌的指导作用.方法 选择经胃镜确诊的幽门螺杆菌阳性慢性胃炎和消化性溃疡患者120例,将120例患者分为三组,各40例.Hp培养组:经胃镜取患者胃窦黏膜组织进行幽门螺杆菌培养和药敏试验,根据药敏结果选择两种敏感抗生素加奥美拉唑治疗,疗程1周;OAM组:奥美拉唑20 mg、阿莫西林1.0、甲硝唑0.4,每天2次,疗程1周;OAC组:奥美拉唑20 mg、阿莫西林1.0、克拉霉素0.5,每天2次,疗程1周;一个月后检测幽门螺杆菌根除情况,观察Hp根除率.结果 Hp培养组、OAM组和OAC组的根除率分别为97.3%、76.3%和77.8%.Hp培养组与其他两组问Hp根除率比较差异均有显著性(P＜0.05),OAM组和OAC组间Hp根除率比较差异无显著性(P＞0.05).结论 根据药敏结果选择两种敏感抗生素加奥美拉唑三联1周疗法治疗Hp感染可获得较高的根除率,是根除Hp的理想方案;幽门螺杆菌药敏试验对临床幽门螺杆菌菌株的根治有指导作用.     

应用质子泵抑制剂 铋剂 呋喃唑酮 左氧氟沙星四联方案根除幽门螺杆菌的临床研究

目的观察质子泵抑制剂(PPI)+铋剂+呋喃唑酮+左氧氟沙星四联方案在治疗幽门螺杆菌(Hp)相关胃十二指肠疾病中的Hp根除率及安全性。方法将临床确诊的142例Hp相关胃十二指肠疾病患者随机分为治疗组(72例)和对照组(70例),治疗组予四联方案治疗,对照组予标准三联方案(PPI+阿莫西林+克拉霉素)治疗。疗程10 d。完成疗程1个月后复查Hp。结果 Hp根除率治疗组(91.67%)显著优于对照组(71.43%)(P0.05)。结论 PPI+铋剂+呋喃唑酮+左氧氟沙星四联方案治疗Hp相关性胃十二指肠疾病,Hp根除率明显高于标准三联组,且副作用较小,值得临床应用。     

铋剂四联方案根除幽门螺杆菌的比较研究

目的 评价含铋剂的不同抗生素的四联方案根除幽门螺杆菌(Hp)的有效性和安全性.方法 将120例Hp感染初次治疗患者随机均分为4组,分别接受了下述7天含铋剂的四联方案:LBAC组:兰索拉唑(15 mg)+果胶铋(0.1 g)+阿莫西林(1 g)+克拉霉素(0.5 g)bid.LBAM组:兰索拉唑(15 mg)+果胶铋(0.1 g)+阿莫西林(1.0g)+甲硝唑(0.4 g)bid.LBCM组:兰索拉唑(15 mg)+果胶铋(0.1 g)+克拉霉素(0.5 g)+甲硝唑(0.4 g)bid.LBLG组:兰索拉唑(15 mg)+果胶铋(0.1 g)+左旋氧氟沙星(0.2 g)+庆大霉素(40 mg)bid.4周后通过14C尿素酶呼吸试验判断根除成功与否.结果 LBAC组22例根除成功,7例发生不良反应.LBAM组18例根除成功,3例发生不良反应.LBCM组14例根除成功,13例发生不良反应.LBLG组21例根除成功,2例发生不良反应.结论 含克拉霉素、阿莫西林的铋剂方案与含左氧氟沙星、庆大霉素的铋剂方案根除Hp疗效相同,含克拉霉素、甲硝唑的四联方案根除率低,应予以放弃.     

三联及四联疗法根除Hp感染的临床疗效及效价比分析

目的评价三联、四联疗法根除幽门螺杆菌（Hp）感染的疗效及效价比。方法将139例Hp感染患者分为三联组、四联组,三联组中的A1组用奥美拉唑＋克拉霉索＋甲硝唑,A2组用奥美拉唑＋克拉霉索＋阿莫西林;四联组中的B1组用奥美拉唑＋克拉霉素＋甲硝唑＋枸橼酸铋钾,B2组用奥美拉唑＋克拉霉素＋阿莫西林＋枸橼酸铋钾,各组疗程均为1周。疗程结束后4周行快速尿素酶试验或”。尿素酶呼气试验,判断Hp根除情况,进行疗效及成本-效价比分析。结果与三联组比较,四联组Hp根除率高,药品费用低（P均〈0．05）,各组均无明显不良反应。结论四联疗法作为一线方案治疗Hp感染,其疗效高于三联疗法,且效价比较高,应作为初治首选。     

Usefulness of vonoprazan,a potassium ion-competitive acid blocker,for primary eradication of Helicobacter pylori

AIM To investigate usefulness of triple therapy with vonoprazan,a potassium ion-competitive acid blocker and antibiotics,for Helicobacter pylori(H.pylori) eradication.METHODS The H.pylori eradication rate was examined in 2507 patients(2055 undergoing primary eradication and 452 undergoing secondary eradication,excluding patients with subtotal gastrectomy) at the Japanese Red Cross Kyoto Daiichi Hospital from March 2013 to September 2015.For patients treated from March 2013 to February 2015,a proton pump inhibitor(PPI) was used to reduce acid secretion,while vonoprazan was used after March 2015.The success rates of the 2 regimens(PPI + amoxicillin + clarithromycin/metronidazole,or vonoprazan + amoxicillin + clarithromycin/metronidazole) were compared.RESULTS The success rate of primary H.pylori eradication was significantly higher in the vonoprazan group.When stratified by the underlying disease,a significant increase of the H.pylori eradication rate was observed in patients with chronic gastritis.A significantly lower H.pylori eradication rate was observed in younger patients compared to older patients in the PPI group,but there was no difference according to age in the vonoprazan group.On the otherhand,the success rate of secondary eradication was similar at approximately 90% in both groups.CONCLUSION Vonoprazan is very useful for primary eradication of H.pylori,and may become a first-line acid secretion inhibitor instead of PPIs.     

An update on anti-Helicobacter pylori treatment in children.

Previous consensus statements have recommended one- to two-week proton pump inhibitor (PPI)-based triple therapies with clarithromycin and either amoxicillin or metronidazole as first-line treatments for children with Helicobacter pylori infection. The objective of the present review was to summarize data from pediatric studies that have examined treatment efficacy, safety, drug resistance and reinfection rates related to anti-H. pylori therapies. Data from a recent meta-analysis of pediatric studies were used along with the authors' existing databases and searches of individual studies. Regimens that were identified as greater than 80% efficacious in children included a two-week therapy with a nitroimidazole and amoxicillin in Europe; a two-week regimen of bismuth, amoxicillin and metronidazole in developed countries (except Spain); a one- to two-week regimen of a PPI, clarithromycin and amoxicillin in Northern Europe, Asia and the Middle East; and a two-week regimen of a PPI, clarithromycin and metronidazole in Canada. Although recommended as a first-line treatment in adults, two-week treatment with a PPI, clarithromycin and amoxicillin eradicated only 68% of H. pylori infections in North American children. Treatment efficacy was reduced in the presence of metronidazole and/or clarithromycin resistance. Further studies of anti-H. pylori treatments in children in North America and developing countries are warranted.     

Ranitidine bismuth citrate-based triple therapies as a second-line therapy for Helicobacter pylori in Turkish patients

BACKGROUND: Quadruple therapy with a proton pump inhibitor, bismuth, metronidazole and tetracycline is recommended as the optimal second-line therapy of Helicobacter pylori infection in the Maastricht Consensus Report. The aim of the present paper was to evaluate the efficacy of ranitidine bismuth citrate (RBC)-based regimens as second-line therapies after failure of the standard Maastricht triple therapy. MATERIALS AND METHODS: One hundred and sixteen H. pylori-positive patients were given omeprazole 20 mg b.d., clarithromycin 500 mg b.d., and amoxicillin 1 g b.d for 10 days. Patients remaining H. pylori-positive (n = 29) were combined with 27 patients enrolled after an initial eradication failure from proton-pump inhibitor (PPI), amoxicillin and clarithromycin therapy for at least 7 days and were randomly given one of the following second-line 10-day treatments: RBC 400 mg b.d., amoxicillin 1 g b.d and clarithromycin 500 mg b.d. (RAC group, n = 28) and RBC 400 mg b.d., metronidazole 500 mg b.d and tetracycline 500 mg b.d. (RMT group, n = 28). Eradication was assessed by either histology and rapid urease test or (13)C urea breath test 8 weeks after therapy. RESULTS: The eradication rate of first-line Maastricht therapy was 67% for intention-to-treat analysis (95% confidence interval [CI]: 58-75). Per-protocol and intention-to-treat eradication was achieved in 60.7% of patients (95%CI: 42-79) in the RAC group and in 85.7% of patients (95%CI: 73-98) in the RMT group (P = 0.03). Fifty-three percent of patients in the RAC and 50% of patients in the RMT group experienced at least one slight side-effect (P = 0.6). CONCLUSIONS: RMT is an effective and well-tolerated second-line therapy after H. pylori eradication failure from PPI, amoxicillin, and clarithromycin.     

'Rescue' therapies for the management of Helicobacter pylori infection

Helicobacter pylori infection is the main cause of gastritis, gastroduodenal ulcer and gastric cancer and should be considered as a major public health issue. According to several international guidelines, first-line therapy for treating H. pylori infection consists of proton pump inhibitor (PPI) or ranitidine bismuth citrate (RBC) with any two antibiotics of amoxicillin, clarithromycin or metronidazole given for 7-14 days. However, even with the recommended treatment regimens, approximately 20% of patients will fail to obtain H. pylori eradication. The proportion of patients with first-line H. pylori therapy failure may be higher in clinical practice and it may increase thanks to diffusion of H. pylori treatment. The recommended second-line therapy is the quadruple regimen composed by tetracycline, metronidazole, bismuth salts and a PPI. However, the efficacy of this regimen is limited by poor patient's compliance due to its side effects, number of tablets per day, and long duration. Moreover, bismuth and metronidazole are not available in all countries. Alternatively, a longer-lasting (i.e. 10-14 days) PPI or RBC triple therapy with two antibiotics has generally been used. In an empirical strategy, the choice of second line depends on the treatment initially used. If a clarithromycin-based regimen was administered in first line, a quadruple regimen or PPI (or RBC) triple therapy with metronidazole and amoxicillin (or tetracycline) should be suggested as a second line. In case of second-line treatment failure, the patient should be evaluated by a case-by-case approach. A susceptibility-guided strategy, if available, is recommended in order to choose the best third-line treatment. Culture can reveal the presence of H. pylori-sensitive strains to clarithromycin (the best effective) or other antimicrobials (such as amoxicillin, metronidazole and tetracycline). Conversely, in an empirical strategy, a third-line not yet used therapy, can reach a high success rate. PPI or RBC, amoxicillin and a new antimicrobial (e.g. rifabutin, levofloxacin or furazolidone) could be used. Several studies have obtained relatively good results with triple therapy combining PPI, rifabutin, and amoxicillin, although a reversible myelotoxicity as leukopenia and thrombocytopenia has been described. Preliminary good results were also achieved with triples PPI regimens combining levofloxacin and amoxicillin without important adverse effects. Furazolidone has also shown efficacy for H. pylori eradication, although untoward reactions could limit its use, especially when high doses are employed. Finally, in more than one H. pylori treatment failure, non-antimicrobial add-on medications (such as lactoferrin, probiotics and others) could be used with the aim either to improve the eradication rate or to minimize side effects.     

Ranitidine bismuth citrate.

Recognition of the relationship between Helicobacter pylori infection and the development of gastroduodenal disease has increased greatly in recent years. To avoid complications of H pylori infection, such as the development of recurrent duodenal and gastric ulcers, effective therapies are required for eradication of the infection. This article reviews ranitidine bismuth citrate (RBC), a novel complex of ranitidine, bismuth and citrate, which was developed specifically for the purpose of eradicating H pylori. Dual therapy with RBC in combination with clarithromycin for 14 days yields eradication rates of 76%. Triple therapy bid for one week with a proton pump inhibitor, clarithromycin and either amoxicillin or a nitroimidazole (tinidazole or metronidazole) is advocated as the treatment of choice for H pylori eradication. Analogous regimens with RBC in place of proton pump inhibitors show effective eradication rates in comparative studies and with pooled data. RBC, used alone or in combination with other antibiotics, appears to be a safe and effective drug for the treatment of H pylori infection. Bismuth levels do not appear to rise to toxic levels.     

Ranitidine bismuth citrate in the treatment of Helicobacter pylori infection.

OBJECTIVE: Examine the effectiveness of treatments that include ranitidine bismuth citrate (RBC) for Helicobacter pylori infection. DESIGN: Prospective and randomised study. PATIENTS AND METHOD: 137 patients were included (62 women, 75 males, average age 46.9 +/- 13) diagnosed with peptic ulcer and infection by Helicobacter pylori. None had received treatment previously. 67 patients were treated with RBC 400 mg bd and clarithromycin 500 mg bd for 14 days, and 70 patients with RBC 400 mg bd, clarithromycin 500 mg bd and amoxycillin 1 g bd for 7 days. The infection eradication was proven eight weeks after treatment end. The efficacy of treatment was evaluated using the intention-to-treat method. The Chisquare test (chi 2) was used for the statistical analysis of data. RESULTS: Infection in 48 out of 67 patients (71.64%) treated with RBC-clarithromycin for 14 days was eradicated, versus 88.57% (62 out of 70) among those treated with RBC-clarithromycin-amoxycillin for 7 days, with a significant difference between both regimens (p < 0.05). CONCLUSIONS: 7-day treatment with RBC-clarithromycin-amoxycillin has a good eradication rate (88.57%) and represents a valid alternative to regimens including a PPI and two antibiotics, as both regimens have a similar efficacy. Results obtained with the double therapy of RBC-clarithromycin for 14 days were not satisfactory, the rate of eradication being 71.64%. The use of an RBC treatment for Helicobacter pylori infection should always be accompanied by two antibiotics in a triple therapy.     

Evaluation of three different proton pump inhibitors with amoxicillin and metronidazole in retreatment for Helicobacter pylori infection

GOALS: We compared the eradication results of retreatment of eradication with proton pump inhibitor (PPI) plus amoxicillin and metronidazole for patients with Helicobacter pylori infection not eradicated by initial treatment with PPI plus amoxicillin and clarithromycin. BACKGROUND: In Japan, the guideline proposes that the use of metronidazole in a triple therapy containing PPI, PPI plus amoxicillin and metronidazole is desirable in retreatment. However, there are no reports comparing various retreatment using different PPIs. METHODS: After initial treatment failure with a PPI plus amoxicillin and clarithromycin, 169 patients were randomized to a PPI (rabeprazole, lansoprazole, or omeprazole) plus amoxicillin and metronidazole given b.i.d. for 7 days. RESULTS: Pretreatment susceptibility testing showed a high level of clarithromycin resistance (78%). The over all eradication rates were similar with the 3 PPIs, 91.1% range 90.1 to 91.4 with intention-to-treat analysis. The presence of metronidazole resistance reduced the eradication rate by approximately 40% (from 96.6% to 57.1%, P<0.05). CONCLUSIONS: In Japan, the combination of a PPI plus amoxicillin and metronidazole provide excellent eradication rates after initial treatment failure with a PPI plus amoxicillin and clarithromycin. The results with metronidazole resistant strains are less satisfactory and pretreatment susceptibility testing may become needed if the prevalence of metronidazole resistant H. pylori increase.     

Optimal therapy for Helicobacter pylori infections

Although Helicobacter pylori infection is both a common and a serious bacterial infection, antimicrobial therapies have rarely been optimized, are prescribed empirically, and provide inferior results compared with antimicrobial therapies for other common infectious diseases. The effectiveness of many of the frequently recommended H. pylori infection treatment regimens has been increasingly compromised by antimicrobial resistance. Regional data on the susceptibility of strains of H. pylori to available antimicrobials are sorely needed. Noninvasive molecular methods are possible to assess clarithromycin susceptibility in isolates obtained from stool specimens. As a general rule, clinicians should prescribe therapeutic regimens that have a ≥90% or, preferably, ≥95% eradication rate locally. If no available regimen can achieve a ≥90% eradication rate, clinicians should use the most effective regimen(s) available locally. Eradication of infection should always be confirmed after treatment in order to provide feedback regarding local effectiveness and an early warning of increasing resistance. In most regions of the world, four-drug treatment regimens, including a PPI plus three antimicrobials (clarithromycin, metronidazole/tinidazole and amoxicillin), or a PPI plus a bismuth plus tetracycline and metronidazole provide the best results. Standard triple therapy (a PPI, amoxicillin and clarithromycin) should now be avoided owing to increasing resistance to this treatment.     

Randomized open trial for comparison of proton pump inhibitors in triple therapy for Helicobacter pylori infection in relation to CYP2C19 genotype

BACKGROUND AND AIMS: Genetic polymorphism of cytochrome P450 (CYP) 2C19 influences the efficacy of Helicobacter pylori eradication therapy with a proton pump inhibitor (PPI) and amoxicillin. However, in triple therapy (PPI plus amoxicillin and clarithromycin), little is known about the impact of CYP2C19 polymorphism, or the use of rabeprazole, which is not well metabolized by CYP2C19. The efficacy of three PPI (omeprazole, lansoprazole, and rabeprazole) in a 1-week triple regimen were compared in relation to CYP2C19 polymorphism. METHOD: One hundred and eighty-three patients were randomized to receive one of the following regimens: amoxicillin 500 mg t.i.d., clarithromycin 200 mg t.i.d., and PPI (omeprazole 20 mg, lansoprazole 30 mg, or rabeprazole 10 mg) b.i.d. CYP2C19 polymorphism was analyzed by PCR restriction fragment length polymorphism. RESULTS: Intention-to-treat-based overall cure rates for omeprazole, lansoprazole or rabeprazole regimens were 83.1% (95% confidence interval (CI): 69-89%), 86.7% (CI: 75-93%), and 76.6% (CI: 64-85%), respectively, without significant difference. The cure rate of the rabeprazole regimen (but not the lansoprazole or omeprazole regimens) tended to be correlated with CYP2C19 genotypes (P = 0.076). In patients with a homozygous extensive metabolizer genotype, the per protocol-based cure rate with rabeprazole (62.5%) was significantly lower than that with lansoprazole (90.0%; P = 0.038). CONCLUSION: The overall cure rate of 1-week triple therapy for H. pylori eradication was not significantly different between regimens with omeprazole, lansoprazole or rabeprazole, but the impact of CYP2C19 genetic polymorphism on the cure rate appeared to differ between these PPI.     

Pantoprazole based therapies in Helicobacter pylori eradication: a systematic review and meta-analysis

AIM: To perform a systematic review on the efficacy of pantoprazole based therapies in Helicobacter pylori eradication, and to conduct a meta-analysis comparing the efficacy of pantoprazole and other proton pump inhibitors (PPIs) when co-prescribed with antibiotics. METHODS: Studies evaluating pantoprazole combined with antibiotics were considered. Only randomized clinical trials comparing pantoprazole and other PPIs when co-prescribed with antibiotics, and differing only in the PPI (pantoprazole vs other), were eligible for inclusion in the meta-analysis. Bibliographical searches in several electronic databases, and manual search of abstracts from congresses, were conducted. The percentage (weighted mean) of patients with eradication success was calculated. Meta-analysis was performed combining the odds ratios (ORs) of the individual studies in a global OR. RESULTS: The mean eradication rate with pantoprazole plus clarithromycin for 14 days was 60%. Cure rates with 7 day pantoprazole based triple regimens were higher: pantoprazole, amoxicillin and clarithromycin (78%); pantoprazole, clarithromycin and nitroimidazole (84%); and pantoprazole, amoxicillin and nitroimidazole (74%). Twelve studies comparing pantoprazole and other PPIs were selected for the meta-analysis, including 534 and 603 patients, respectively. The mean eradication rate for H. pylori using pantoprazole plus antibiotics was 83%, and 81% when other PPIs were used (OR = 1; 95% confidence interval (CI) from 0.61 to 1.64). When sub-analysis was performed, including only studies comparing pantoprazole with omeprazole, or pantoprazole with lansoprazole, differences were also statistically non-significant. The meta-analysis of the six studies prescribing equivalent doses of all PPIs demonstrated similar results with pantoprazole and with other PPIs (OR = 1.07; 95% CI from 0.71 to 1.62), the results being statistically homogeneous. CONCLUSIONS: Pantoprazole achieves similar cure rates to those of omeprazole and lansoprazole when co-prescribed with antibiotics for the eradication of H. pylori infection.