左氧氟沙星四联疗法根除幽门螺杆菌感染疗效观察

目的观察左氧氟沙星短程四联疗法根除幽门螺杆菌（Hp）感染的疗效。方法 160例Hp阳性病人慢性胃炎和消化性溃疡患者,随机分为两组。治疗组采用雷贝拉唑10mg,阿莫西林1000mg,左氧氟沙星0.2g,呋喃唑酮0.2g,口服,均每日2次,疗程一周;对照组采用雷贝拉唑10mg,阿莫西林1000mg,克拉霉素0.5g,口服,均每日2次,疗程一周,停药1个月后,应用14C-UBT法检测Hp的根除率。结果治疗组根除率为95%明显高于对照组根除率75%,P〈0.05。结论雷贝拉唑、阿莫西林、左氧氟沙星、呋喃唑酮四联疗法的Hp根除率高,毒副作用小,是根除Hp的理想方案,值得推广。     

含左氧氟沙星的四联方案补救治疗幽门螺杆菌的临床研究

目的 评价含左氧氟沙星的四联方案补救治疗幽门螺杆菌的有效性和安全性。方法 33例幽门螺杆菌初次根除失败的消化性溃疡或慢性萎缩性胃炎患者接受了下述10天含左氧氟沙星的四联方案：质子泵抑制剂（标准剂量）＋枸橼酸铋钾（0．22g）＋左旋氧氟沙星（0．2g）＋阿莫西林（1．0g）b．d，4周后通过^13C-尿素酶呼吸试验判断根除成功与否。结果 2例失访，余31例完成治疗及随访，其中26例补救根除成功，5例补救治疗失败，6例（18．18％）患者发生轻微不良反应，根据意向处理分析（ITT）和完成治疗分析（PP），根除率分别为78．79％和83．87％。结论 含左氧氟沙星的四联方案为安全有效的幽门螺杆菌补救治疗方案。     

含左氧氟沙星的一线方案根除幽门螺杆菌疗效分析

目的 观察含左氧氟沙星的三联疗法根除幽门螺杆菌(Hp)的疗效.方法 选择98例有消化道症状的Hp阳性患者,随机分为3组,A组采用埃索美拉唑、阿莫西林、克拉霉素;B组采用埃索美拉唑、阿莫西林、左氧氟沙星;C组采用埃索美拉唑、克拉霉素、左氧氟沙星,疗程均为7 d.疗程结束后4周复查Hp.结果 A、B、C组Hp根除率分别为59.38%、96.97%、78.79%,B组优于A、C组,后两组间无明显差异;症状缓解率分别为90.62%、93.94%、90.91%,组间无统计学差异.结论 采用左氧氟沙星作为一线根除Hp方案根除率高,患者易于接受,是一种较为理想的治疗方案.     

左氧氟沙星三联疗法根除幽门螺杆菌临床观察

观察左氧氟沙星、埃索美拉唑、阿莫西林三联疗法对幽门螺杆菌（npylori）治疗失败后的患者复治的疗效,选取62例经抗Mpylori一线治疗后^14C-尿素呼气试验证实幽门螺杆菌感染仍阳性的患者参与研究,将患者随机分为治疗组和对照组,治疗组34例,用左氧氟沙星、埃索美拉唑、阿莫西林三联疗法。对照组28例,用奥美拉唑、铋剂、阿莫西林、甲硝唑四联疗法。两组对再次治疗病例H．pylori根除率分别为85．29％、75％。差异无统计学意义（P〉0．05）。结果表明左氧氟沙星、埃索美拉唑、阿莫西林三联疗法对H．pylori治疗失败后的H．pylori根除率与以铋剂为基础加质子泵抑制剂（PPI）的四联疗法对H．pylori的根除率接近,但用药简单,患者易于接受。     

左氧氟沙星三联根除幽门螺杆菌的疗效观察

目的观察含有左氧氟沙星14d三联疗法根除幽门螺杆菌（Hp）的疗效及安全性。方法选择90例符合条件的Hp阳性患者分成两组,治疗组采用泮托拉唑（40mg,2次/d）、左氧氟沙星（500mg,1次/d）、阿莫西林（1000mg,2次/d）,治疗14d;对照组采用奥美拉唑（20mg,2次/d）、克拉霉素（500mg,2次/d）、甲硝唑（400mg,2次/d）,治疗14d。疗程结束4周后复查碳14呼气试验,观察Hp根除率和不良反应。结果治疗组意图治疗（ITT）和试验方案分析（PP）Hp根除率分别为91.1%和95.3%,而对照组为ITT和PP的Hp根除率分别为73.3%和80.5%。两组根除率比较差异有统计学意义（P〈0.05）,治疗组和对照组不良反应分别为3例和7例,两组比较有统计学差异（P〈0.05）。结论使用雷贝拉唑、左氧氟沙星、阿莫西林14d三联疗法是一种疗效高、不良反应少的Hp根除方案,可作为Hp根除的一线治疗方案。     

左氧氟沙星三联疗法根除幽门螺杆菌临床观察

目的观察左氧氟沙星、兰索拉唑、阿莫西林三联疗法对幽门螺杆菌（Hp）治疗失败后的患者复治的疗效。方法经抗Hp一线治疗后C^14呼气试验仍阳性，62例慢性胃炎病例，随机分为治疗组和对照组，治疗组34例，左氧氟沙星、兰索拉唑、阿奠西林三联疗法。对照组28例，奥美拉唑、铋剂、阿莫西林、甲硝唑四联疗法，比较两组的治疗结果。结果治疗组对再次治疗病例Hp根除率为85．29％，对照组为75％，两组Hp比较无统计学意义（P〉0．05）。结论左氧氟沙星、兰索拉唑、阿莫西林三联疗法对Hp治疗失败后的Hp根除率与以铋剂为基础加质子泵抑制剂（PPI）的四联疗法对Hp的根除率接近，但用药简单，患者易于接受。     

含左氧氟沙星的四联方案与常规四联方案补救治疗幽门螺杆菌感染疗效分析

目的 探讨含左氧氟沙星的四联补救方案抗幽门螺杆菌(HP)治疗的疗效和药物副作用.方法 将HP感染经常规三联疗法(奥美拉唑 阿莫西林 克拉毒素)治疗失败的84例患者分为A组(44例)和B组(40例).A组患者给予以左旋氧氟沙星为主的四联补救治疗7天(左氧氟沙星 奥美拉唑肠溶片 阿莫西林 胶体果胶铋),B组患者使用常规四联7天(洛赛克 胶体果胶铋 克拉毒素 甲硝唑)补救疗法,4周后做13c尿素酶呼吸试验,并作比较.结果 A组3例失访,余41例完成治疗及随访,其中36例(89.7%)补救根除成功,5例(11.3%)补救治疗失败,7例(17.1%)患者发生轻微不良反应;B组4例失访,25例(69.3%)根除成功,8例(22.2%)患者发生轻微不良反应,A、B两组Hp根除率比较有显著性差异(P＜0.05).结论 含左氧氟沙星的四联方案为安全有效的幽门螺杆菌补救治疗方案.     

左氧氟沙星和奥硝唑在根除幽门螺杆菌中的作用

幽门螺杆菌（helicobater,Hp）在全球的感染率超过50％,在发展中国家,Hp感染率更高,现已确认Hp感染与慢性胃炎、消化性溃疡、胃癌、胃黏膜相关淋巴组织（mucosa—associated lymphcid tissue malt）淋巴瘤的发生密切相关,世界卫生组织也将Hp列入Ⅰ类致癌因子,根除Hp已成为Hp阳性的消化性溃疡、慢性胃炎、早期胃癌术后及胃MALT淋巴瘤等上消化道疾病患者必须进行治疗。     

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.     

我国幽门螺杆菌感染处理共识推荐的铋剂四联方案根除率分析

背景:随着幽门螺杆菌(Hp)耐药率的上升及其所导致的标准三联疗法根除率的下降,铋剂四联方案成为我国最新共识推荐的Hp感染根除治疗方案。目的:评价各共识推荐铋剂四联方案的根除治疗效果,为高效、价廉的根除治疗方案的选择提供参考。方法:检索CNKI、万方、维普数据库,纳入我国2011-2013年间公开发表,采用共识推荐的铋剂四联方案根除Hp感染的临床试验类文献。提取文献资料,根据Graham等提出的Hp根除率分级系统,对根除率进行分析。结果:共166篇文献入选,包括Hp感染根除试验192项。在全国范围内,含阿莫西林方案的根除率大部分可以接受,其中PAFB(PPI+阿莫西林+呋喃唑酮+铋剂)方案取得优异根除率(≥95%)的可能性最高。在华东和中南地区,相应的适宜根除治疗方案分别为PACB(PPI+阿莫西林+克拉霉素+铋剂)和PAFB方案。适宜疗程为14 d。结论:在各共识推荐铋剂四联方案中,PAFB方案具有明显的效益和成本优势。在全国范围内,非阿莫西林过敏个体行Hp感染根除治疗宜优先选用PAFB方案,建议疗程为14 d。     

嗜酸乳杆菌联合三联方案根除幽门螺杆菌的效果分析

目的通过嗜酸乳杆菌联合标准三联方案5周疗法,探讨嗜酸乳杆菌对提高三联方案幽门螺杆菌(Helicobacter pylori,H.pylori)根除率的作用。方法分析我院消化内科门诊H.pylori阳性初治患者134例临床资料。将134例患者分为治疗组和对照组,治疗组采用嗜酸乳杆菌+标准三联方案5周疗法,对照组采用标准三联方案1周疗法。结果所有患者均按时完成治疗,完成随访的117例患者中,治疗组61例,治愈53例,治愈率86.9%;对照组56例,治愈40例,治愈率71.4%;两组比较有统计学差异(P<0.05)。结论嗜酸乳杆菌能提高三联方案H.pylori根除率,患者服药副作用小,依从性好,具有应用价值。     

Maastricht Ⅱ treatment scheme and efficacy of different proton pump inhibitors in eradicating Helicobacter pylori

AIM: The Maastricht Ⅱ criteria suggest the use of amoxicillin and clarithromycin in addition to a proton pump inhibitor over 7-10 d as a first line therapy in the eradication of Helicobacter pylori(H pylori). For each proton pump inhibitor, various rates of eradication have been reported. The present study was to compare the efficacy of different proton pump inhibitors like omeprazole, lansoprazole and pantoprazole in combination with amoxicillin and clarithromycin in the first line eradication of H pylori and to investigate the success of H pylori eradication in our district.METHODS: A total of 139 patients were included having a Helicobacter pylori(+) gastroduodenal disorders diagnosed by means of histology and urease test. Besides amoxicillin (1 000 mg twice a day) and clarithromycin (500 mg twice a day), they were randomized to take omeprazole (20 mg twice a day), or lansoprazole (30 mg twice a day), or pantoprozole (40 mg twice a day) for 14 d. Four weeks after the therapy, the eradication was assessed by means of histology and urease test. It was evaluated as eradicated if the H pylori was found negative in both. The complaints (pain in epigastrium, nocturnal pain, pyrosis and bloating)were graded in accordance with the Licert scale. The compliance of the patients was recorded.RESULTS: The eradication was found to be 40.8% in the omeprazole group, 43.5% in the lansoprazole group and 47.4% in the pantoprazole group. Sixty-three out of 139patients (45%) had eradication. No statistically significant difference was observed between the groups. Significant improvements were seen in terms of the impact on the symptom scores in each group.CONCLUSION: There was no difference between omeprazole, lansoprazole and pantoprazole in H pylori eradication, and the rate of eradication was as low as 45%.Symptoms were improved independent of the eradication in each treatment group. The iow eradication rates suggest that the antibiotic resistance or the genetic differences of the microorganism might be in effect. Further studies are required to verify these suggestions.     

Maastricht Ⅱ treatment scheme and efficacy of different proton pump inhibitors in eradicating Helicobacter pylori

AIM: The Maastricht Ⅱ criteria suggest the use of amoxicillin and clarithromycin in addition to a proton pump inhibitor over 7-10 d as a first line therapy in the eradication of Helicobacter pylori (Hpylori). For each proton pump inhibitor, various rates of eradication have been reported. The present study was to compare the efficacy of different proton pump inhibitors like omeprazole, lansoprazole and pantoprazole in combination with amoxicillin and clarithromycin in the first line eradication of Hpylonand to investigate the success of H pylonrieradication in our district. METHODS: A total of 139 patients were included having a Helicobacter pylori (+) gastroduodenal disorders diagnosed by means of histology and urease test. Besides amoxicillin (1000 mg twice a day) and darithromycin (500 mg twice a day), they were randomized to take omeprazole (20 mg twice a day), or lansoprazole (30 mg twice a day), or pantoprozole (40 mg twice a day) for 14 d. Four weeks after the therapy, the eradication was assessed by means of histology and urease test. It was evaluated as eradicated if the Hpyloriwas found negative in both. The complaints (pain in epigastrium, nocturnal pain, pyrosis and bloating) were graded in accordance with the Licert scale. The compliance of the patients was recorded. RESULTS: The eradication was found to be 40.8% in the omeprazole group, 43.5% in the lansoprazole group and 47.4% in the pantoprazole group. Sixty-three out of 139 patients (45%) had eradication. No statistically significant difference was observed between the groups. Significant improvements were seen in terms of the impact on the symptom scores in each group. CONCLUSION: There was no difference between omeprazole, lansoprazole and pantoprazole in H pylori eradication, and the rate of eradication was as low as 45%. Symptoms were improved independent of the eradication in each treatment group. The low eradication rates suggest that the antibiotic resistance or the genetic differences of the microorganism might be in effect. Further studies are required to verify these suggestions.     

Efficacy and safety of bismuth quadruple regimens containing tetracycline or furazolidone for initial eradication of Helicobacter pylori

Helicobacter pylori (H pylori) infection can cause chronic gastritis, peptic ulcer, and even gastric cancer, so effective eradication is critical.This study compared the efficacy and safety of bismuth quadruple regimens including either tetracycline or furazolidone for initial eradication.Patients newly diagnosed with H pylori infection from January 2020 to January 2021 were randomly assigned to receive either the tetracycline-containing regimen (n = 116) or furazolidone-containing regimen (n = 168). Both regimens included 1 proton pump inhibitor (rabeprazole 20 mg, or esomeprazole 20 mg, or eprazole 5 mg), colloidal pectin bismuth 300 mg, and amoxicillin 1000 mg in addition to tetracycline 1.0 g or furazolidone 0.1 g. All drugs were administered twice daily for 12 consecutive days. The ¹⁴C urea breath test was used for diagnosis, and re-test negativity at one-month follow-up was considered successful eradication. Adverse events were recorded during follow-up by telephone interview.In total, 109 patients in the tetracycline group and 157 in the furazolidone group were re-examined at 1 month. In the tetracycline group, 101 patients tested negative at follow-up, yielding an eradication rate of 92.7% according to per-protocol analysis and 87.1% by intention-to-treat analysis. In the furazolidone group, 141 patients tested negative, yielding eradication rates of 89.8% by PP and 83.9% by ITT. Eradication rates did not differ significantly between regimens (per-protocol: χ² = 0.637, P = .517; intention-to-treat: χ² = 0.537, P = .501). However, total adverse events incidence was significantly lower in the tetracycline group (20.2% vs 37.6%; χ² = 9.193, P = .003).Both bismuth quadruple regimens produce high initial eradication, but the tetracycline regimen appears safer.     

Comparative study: Vonoprazan and proton pump inhibitors in Helicobacter pylori eradication therapy

AIM To compare the effectiveness and safety of vonoprazan-based therapy with proton pump inhibitor(PPI)-based therapies to treat Helicobacter pylori(H. pylori).METHODS We retrospectively analysed data from first-line(vonoprazan or PPI with 200 mg clarithromycin and 750 mg amoxicillin twice daily for 7 d)(n = 1353) and second-line(vonoprazan or PPI with 250 mg metronidazole and 750 mg amoxicillin twice daily for 7 d)(n = 261) eradication treatments for H. pylori- positive patients with associated gastrointestinal diseases from April 2014 to December 2015 at Hattori Clinic, Japan. The primary endpoint was the eradication rate, which was assessed with a full analysis set. The secondary endpoints were adverse events and related factors.RESULTS After the first-line treatments, the eradication rates for vonoprazan, esomeprazol, rabeprazole, and lansoprazole were 87.9%(95%CI: 84.9%-90.5%), 71.6%(95%CI: 67.5%-75.5%), 62.9%(95%CI: 52.0%-72.9%), and 57.3%(95%CI: 50.4%-64.1%), respectively. The vonoprazan eradication rate was significantly higher than that of the PPIs(P 0.01). Interestingly, smoking did not affect the H. pylori eradication rate in the vonoprazan group(P = 0.34), whereas it decreased the rates in the PPI groups(P = 0.013). The incidence of adverse events in the vonop-razan group was not different from the PPI group(P = 0.054), although the vonoprazan group exhibited a wider range of adverse events. Vonoprazan-based triple therapy was highly effective as a second-line treatment, with an eradication rate similar to that of PPI-based therapy.CONCLUSION Vonoprazan might be superior to PPIs in first-line H. pylori therapy, particularly for smokers. However, caution is required due to possible adverse events.     

Resistance of Helicobacter pylori to furazolidone and levofloxacin: A viewpoint

In their review, Arslan et al[1] did not describe the status of Helicobacter pylori(H. pylori) treatment with furazolidone and the resistance to this antibiotic. We have presented different surveys showing the resistance of H. pylori to furazolidone from Asia and South America. The resistance rates varied but were mostly low( 5%). There are not enough data on its efficacy and resistance in the United States and Europe. H. pylori mutations occurring in the oor D gene, including A041 G, A122 G, C349A(G), A78 G, A112 G, A335 G, C156 T and C165 T, and in the por D gene, including G353 A, A356 G, C357 T, C347 T, C347 G and C346 A, have been indicated to be possibly related to the observed resistance. Additionally, to complete Arslan et al 's statement regarding levofloxacin resistance, it should be noted that compound mutations of N87 A, A88 N and V65 I at codon Asn-87 were recently observed in the gyr A gene for the first time. However, the results on these topics are not sufficient, and more worldwide studies are suggested.     

Ten-day triple therapy with ranitidine bismuth citrate, amoxicillin, and clarithromycin in eradicating Helicobacter pylori

OBJECTIVE: Fourteen-day therapy with ranitidine bismuth citrate, amoxicillin, and clarithromycin has been shown to have a high Helicobacter pylori eradication rate (> 90%) in U.S. trials. The aim of this study was to determine the H. pylori eradication rate of a ranitidine bismuth citrate-based triple regimen of shorter duration (10 days), which has been shown to be effective in Europe. METHODS: Dyspeptic patients who had a positive baseline 13C-urea breath test and either a positive antral rapid urease test or positive IgG serology were studied. Treatment consisted of ranitidine bismuth citrate 400 mg, clarithromycin 500 mg, and amoxicillin 1 g, all given b.i.d. for 10 days. Eradication was determined >4 wk after completion of therapy by the 13C-urea breath test (enrichment <2.4%). Results are expressed for intent-to-treat (all patients randomized even if they did not take the drug) and per-protocol (major protocol violators excluded) analyses. RESULTS: Seventy-seven patients with a mean age of 48 +/- 1.8 yr were studied. Forty-eight patients had eradication of H. pylori with this regimen (62%), 16 patients (21%) did not have eradication, and 13 patients (17%) did not return for breath testing. By intent-to-treat analysis the eradication rate was 62% (95% confidence intervals [CI], 51%, 73%) and by per-protocol analysis the eradication rate was 75% (95% CI, 63%, 85%). CONCLUSIONS: Ten-day, twice-daily therapy with ranitidine bismuth citrate, amoxicillin, and clarithromycin has an eradication rate that ranges from 62-75%. Fourteen-day therapy may be preferable because of higher eradication rates.