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.     

酪酸梭菌活菌片联合四联疗法治疗幽门螺杆菌感染的临床研究

[目的]观察酪酸梭菌活菌片联合四联疗法治疗幽门螺杆菌(Helicobacter pylori,Hp)感染疾病的疗效。[方法]~(14)C尿素呼气试验结果阳性的132例患者随机分为A组、B组。A组给予四联疗法,即雷贝拉唑肠溶片(20mg,2次/d)、枸橼酸铋钾颗粒(2g,2次/d)、阿莫西林胶囊(1g,2次/d)、盐酸左氧氟沙星片(0.2g,2次/d);B组在A组治疗的基础上加用酪酸梭菌活菌片(0.7g,3次/d);2组疗程均为14d。比较2组患者治疗后Hp根除率、症状缓解率及不良反应发生率。[结果]B组Hp根除率明显高于A组,差异有统计学意义(P0.05)。B组药物不良反应的发生率明显低于A组,差异有统计学意义(P0.05)。2组患者治疗后症状缓解率比较差异无统计学意义。[结论]酪酸梭菌活菌片联合四联疗法治疗Hp感染可提高Hp根除率,降低不良反应,值得临床进一步研究。     

Beta-lactamase inhibitor enhances Helicobacter pylori eradication rate

OBJECTIVES: One-week triple therapy, a combination of acid suppression with two antibiotics, is the gold standard for anti-Helicobacter pylori treatment. There is increasing evidence of H. pylori resistance to classical triple therapy. Recently, it was reported that the amoxicillin-clavulanate combination had a slightly higher activity than amoxicillin alone against H. pylori, and that beta-lactamase inhibitors had 'in-vitro' antibacterial activity against H. pylori. SETTING: To evaluate the efficacy of 1 week triple therapy omeprazole, clarithromycin and amoxicillin plus clavulanate compared with omeprazole, clarithromycin and amoxicillin for H. pylori eradication. The study was open randomized. SUBJECTS: Sixty dyspeptic patients (36 male, 24 female; mean age 53 +/- 9 years) with Helicobacter pylori infection never treated before, were enrolled and randomly assigned to two different 7-day triple therapies: (i) (n = 30) amoxicillin 875 mg plus clavulanic acid 125 mg b.i.d., clarithromycin 500 mg b.i.d., omeprazole 20 mg b.i.d. (ACCO); (ii) (n = 30) amoxicillin 1 g b.i.d., clarithromycin 500 mg b.i.d., omeprazole 20 mg b.i.d. (ACO). Bacterial eradication was assessed by 13C-urea breath test 4-6 weeks after therapy. Information on gastrointestinal symptoms and antibiotic-related side-effects were recorded using a questionnaire. RESULTS: All patients completed the study. A significantly higher H. pylori eradication rate with ACCO compared with ACO: (26/30) 86.6 vs. (20/30) 66.6%, respectively (P < 0.05) were observed. No major side-effects were reported, whilst 8% patients complained of mild side-effects; no significant differences were noted between the two groups. CONCLUSIONS: Our results suggest that amoxicillin and clavulanate in combination achieve a higher H. pylori eradication rate than amoxicillin alone, without any increase in side-effects. The combination of amoxicillin and clavulanate may represent an alternative therapeutic scheme for the treatment of H. pylori infection.     

Efficacy of quadruple therapy for Helicobacter pylori eradication after failure of proton pump inhibitor‐based triple therapy in Singapore

BACKGROUND: Helicobacter pylori eradication is the mainstay in the treatment of H. pylori‐associated peptic ulcer disease. Current standard eradication therapy consists of 1 week of treatment with a proton pump inhibitor (PPI) and two antibiotics selected from amoxicillin, metronidazole and clarithromycin. In this study we aimed to assess the efficacy of quadruple therapy consisting of a PPI, bismuth, tetra‐cycline and metronidazole in patients for whom initial H. pylori eradication using a triple therapy regimen consisting of a PPI, amoxicillin and clarithromycin was unsuccessful. METHODS: Consecutive patients with H. pylori‐associated peptic ulcer disease, in whom H. pylori with triple therapy had been unsuccessful, were included in the study. These patients had been treated with a regimen that included a PPI (standard dose twice daily), amoxicillin (1 g twice daily) and clarithro­mycin (500 mg twice daily) for 1 week during 1997?2001. Diagnosis of peptic ulcer disease was made at esophagogastroduodenoscopy. Helicobacter pylori infection was considered to be present on the basis of either a positive rapid urease test, positive histo­logical identification of H. pylori or both. Failure of initial H. pylori eradication was established with either a rapid urease test, a ¹³C urea breath test or histology. Quadruple therapy consisted of a PPI (standard dose twice daily), metronidazole (400 mg three times daily), tetracycline (500 mg four times daily) and bismuth subcitrate (240 mg twice daily). Failure of quadruple therapy was diagnosed on the basis of a positive ¹³C urea breath test. RESULTS: Fifty‐three patients received quadruple therapy. The median age was 52 years (range 20?74) and the male to female ratio was 42 : 11. On an intent‐to‐treat basis, the eradication rate was 69.8%, whereas on a per‐protocol basis, the eradication rate was 82.2%. CONCLUSION: We conclude that a 1‐week quadruple therapy regime consisting of a PPI, bismuth, tetracycline and metronidazole was effective in 82.2% of patients who experienced an unsuccessful initial H. pylori eradication attempt with PPI, amoxicillin and clarithromycin.     

四联疗法与序贯疗法在幽门螺杆菌根除补救治疗中的疗效比较

[目的]比较四联疗法与序贯疗法在幽门螺杆菌(Hp)根除补救治疗中的疗效及安全性,旨在寻找一种有效、安全、经济的补救治疗方案。[方法]将首次根除Hp治疗失败的90例慢性胃炎患者,随机分为四联疗法组和序贯疗法组,每组45例。四联疗法组患者治疗方案为埃索美拉唑、枸橼酸铋钾、阿莫西林、莫西沙星,疗程14d。序贯疗法组患者治疗方案为前5d给予埃索美拉唑、阿莫西林;后5d给予埃索美拉唑、克拉霉素、奥硝唑。所有患者在疗程结束停药4周后行14 C尿素呼气试验检测Hp。比较2组患者治疗前后的不良反应。[结果]四联疗法组Hp根除率(91.1%)显著高于序贯疗法组(75.6%),差异有统计学意义(P<0.05)。2组不良反应均很轻微,组间不良反应发生率比较差异无统计学意义(P>0.05)。[结论]对于Hp补救治疗,四联疗法较序贯疗法疗效更好,且不良反应小,患者依从性好,值得在临床上推广。     

Non-bismuth quadruple therapy for first-line Helicobacter pylori eradication: A randomized study in Japan

AIM:To find the way to improve the eradication rate of first-line therapy in Japanese patients.METHODS:We prospectively compared the effectiveness of 7-d quadruple therapy to standard 7 d triple therapy in Japanese patients infected with Helicobacter pylori(H.pylori).One hundred and nineteen patients were randomly assigned to receive 7-d non-bismuth quadruple therapy with lansoprazole,amoxicillin,clarithromycin and metronidazole(LACM7) or 7-d triple therapy with lansoprazole,amoxicillin and clarithromycin(LAC7).After three months,H.pylori status was analyzed by 13C-urea breath test.Incidence rates of adverse events were evaluated by use of questionnaires.RESULTS:By intention-to-treat(ITT) analysis,the eradication rate in the LACM7 group was 94.9%,which was significantly higher than the LAC7 group(68.3%,P < 0.001).Per protocol analysis also showed a significantly higher eradication rate in the LACM7 group(98.3%) than the LAC7 group(73.2%,P < 0.001).Nevertheless,the incidence of serious adverse events did not differ between the two groups(RR:1.10,95% CI:0.70-1.73,P = 0.67).CONCLUSION:Seven day non-bismuth quadruple therapy(LACM7) was superior to standard 7-d triple therapy(LAC7) for first-line eradication.     

共同治疗策略对根除幽门螺杆菌的影响

[目的]研究存在幽门螺杆菌(Hp)感染家庭聚集的感染患者Hp根除治疗后复发情况,探讨共同根除治疗策略对远期根除Hp的影响。[方法]通过对内镜检查确诊的195例Hp感染患者的家庭成员采用13碳呼气试验进行Hp感染调查,筛选有家庭成员Hp感染的患者140例。按照对Hp感染家庭成员有无根除治疗,将140例随机分成家庭成员共同根治组和单独根治组,每组70例。治疗后每月随访患者感染复发情况,观察不同根治策略对Hp根除的影响。[结果]134例患者参与根治后4、6、12、18、24个月随访,其中家庭成员共同根除治疗患者68例,Hp感染复发患者分别为0、1、2、4、5例,累积复发率为7.4%,平均复发时间为(12.6±6.1)个月;而66例单独根治患者复发者则分别为3、5、9、11、13例,累积复发率为19.7%,平均复发时间为(11.1±6.3)个月。χ2检验分析发现,在根除治疗后4、6个月时,2组复发率比较差异无统计学意义(P0.05);随着时间推移,治疗后12、18、24个月,共同根治组患者Hp感染再发率显著少于单独根治组(P0.05)。[结论]从远期观察,对于存在Hp感染家庭聚集的Hp感染患者,Hp感染成员共同根除治疗可有效降低根治后感染再发。     

喹诺酮类抗生素一线根除幽门螺杆菌研究现状

幽门螺杆菌(Hp)对甲硝唑或克拉霉素耐药率的不断升高是导致根除失败的主要原因。目前喹诺酮类在根除Hp治疗中的作用已受到重视。本文拟就第三代和第四代喹诺酮类药物左氧氟沙星和莫西沙星在一线根除Hp中的作用作一综述。     

Quadruple therapy for eradication of Helicobacter pylori

AIM:To investigate quadruple therapy with rabeprazole,amoxicillin,levofloxacin and furazolidone for the eradication of Helicobacter pylori (H.pylori) infection.METHODS:A total of 147 patients were divided into the experimental treatment group (n=78) and the standard triple treatment group (n=69).The experimental treatment group received rabeprazole 20 mg,amoxicillin 1.0 g,levofloxacin 0.2 g and furazolidone 0.1 g,twice daily.The standard triple treatment group received omeprazole 20 mg,amoxicillin 1.0 g and clarithromycin 0.5 g,twice daily.RESULTS:One month after treatment,the 13 C urea breath test was carried out to detect H.pylori.The eradication rate using per-protocol analysis was 94.3% in the experimental treatment group and 73% in the standard triple treatment group (P < 0.05),and using intention to test analysis,these figures were 86% and 67% in the two groups,respectively.Side effects were observed in 34 patients,and included mild dizziness,nausea,diarrhea and increased bowel movement.Eleven of the 34 patients needed no treatment for their side effects.CONCLUSION:Rabeprazole,amoxicillin,levofloxacinand furazolidone quadruple therapy is a safe method for the eradication of H.pylori with high efficacy and good tolerability.     

幽门螺杆菌的形态变异及返祖

目的幽门螺杆菌（Ｈｐ）在体外很易发生球形变,目前一般认为是不能培养的退化状态．而对Ｈｐ在环境中生存方式和如何感染大量人群仍不清楚,为此本研究对Ｈｐ的形态变化尤其是球形变的返祖进行了研究．方法本研究通过对１８株Ｈｐ在不同条件下的培养,观察其生存及形态变化,并在加有鸡蛋和小牛血清的空弯培养基上及加有血清有布氏肉汤培养基中是进行培养和返祖,观察其变异规律．结果Ｈｐ可在室温液体中繁殖,１８株中观察到３株球形体Ｈｐ在室温下的返祖,除常见球形变外的Ｈｐ杆状弯曲、长杆状、短杆状、长丝体、巨球体、丝球体、原生质体及细小“Ｓ”和弧形变异．并根据Ｈｐ形态变化的顺序及表型,初步发现Ｈｐ由典型“Ｓ”或多螺旋形态变为杆状弯曲、长杆状、短杆状、然后变为球形、长丝体、巨球体、丝球体、原生质体的规律．部分变异体在一定条件下可返祖．结论Ｈｐ易发生多形变化,有一定规律．可在室温下生长繁殖,球形体可在Ｈｐ鸡蛋培养基上或室温液体培养基中返祖．提示Ｈｐ的球形变在其感染和治疗后的复发中起重要作用     

幽门螺杆菌根除效果的影响因素分析

幽门螺杆菌(Helicobacter pylori,H.pylori)感染是最常见的细菌感染之一,影响着世界约50%的人口,被世界卫生组织定义为胃癌致病因子。H.pylori根除治疗可以降低消化性溃疡、胃癌等疾病的发病风险。目前H.pylori根除率呈逐渐下降的趋势。加深对其根除率影响因素的了解,可能有助于制定更为有效的根除治疗或预防感染的方案。本文结合国内外相关研究,对影响H.pylori根除率的因素作一概述。     

Comparison of the efficacy of triple versus quadruple therapy on the eradication of Helicobacter pylori and antibiotic resistance

OBJECTIVE: Our aim was to compare the efficacy and safety of Helicobacter pylori (H. pylori) eradication with pantoprazole-based 7-day standard triple therapy (PAC) and 10-day quadruple therapy (PBMT), and to study the primary resistance of H. pylori to amoxicillin, clarithromycin, metronidazole and tetracycline. METHODS: A total of 170 patients with non-ulcer dyspepsia (NUD) and H. pylori infection were allocated to two study groups. The PAC group received pantoprazole 40 mg b.i.d., amoxicillin 1.0 g b.i.d. and clarithromycin 500 mg b.i.d. for 7 days; the PBMT group received pantoprazole 40 mg b.i.d., colloidal bismuth subcitrate 220 mg b.i.d, metronidazole 400 mg t.i.d. and tetracycline 750 mg b.i.d. for 10 days. A total of 80 H. pylori strains were isolated and antibiotic resistance was measured by the agar dilution method. RESULTS: A total of 166 patients completed the therapy. The intention-to-treat eradication rates in the PAC and PBMT groups were 63.5% and 89.4%, respectively (P < 0.05). By per protocol analysis, the eradication rates of the two groups were 65.1% and 91.6%, respectively (P < 0.05). Overall 77 clinical isolated H. pylori strains were cultured successfully. The H. pylori primary resistance rates to metronidazole and clarithromycin were 41.6% and 20.8%, respectively, whereas all the H. pylori isolates were sensitive to amoxicillin and tetracycline. CONCLUSION: The efficacy of PAC declines in many regions in China because of high antibiotic resistance rates. The PBMT regimen achieved a high eradication rate of H. pylori and might be used as a first-line therapy.     

A new quadruple therapy for the eradication of Helicobacter pylori. Effect of pretreatment with omeprazole on the cure rate

To elucidate whether pretreatment with omeprazole decreases the cure rate of Helicobacter pylori infection with a new quadruple therapy, and thus, whether this pretreatment should not be used in clinical practice, we conducted a randomized trial. Ninety patients with chronic peptic ulcer disease and nonulcer dyspepsia, with biopsy-proven H. pylori infection were randomly assigned to the two following regimens: Group 1 (n = 45) received omeprazole 20 mg once daily for 2 weeks (days 1–14), and 500 mg amoxicillin granules and 250 mg metronidazole thrice daily, and roxithromycin 150 mg twice daily for 1 week (days 8–14), Group 2 (n = 45) received the same antibiotic treatment as group 1 for 1 week (days 1–7), in addition to omeprazole treatment for 2 weeks (days 1–14). Four weeks after the treatment ended, endoscopy was repeated, with two biopsy specimens each taken from the antrum and the corpus (total of four specimens) for a urease test, histological analysis, and culture to establish cure of infection. A patient was regarded as cured only if all three methods gave negative results for H. pylori. In the intention-to-treat analysis, 42 of 45 patients (93.3%; 95% confidence intervals [CI], 81.7%–98.6%) in group 1 were cured compared with 43 of 45 patients (95.6%; 95% CI, 84.9%–99.5%) in group 2. In the per-protocol analysis, the corresponding figures were 42/44 (95.5%; 95% CI 84.5%–99.4%) and 43/44 (97.7%; 95% CI, 88.0%–99.9%). There were no significant differences in the cure rate between the two groups on either analysis. All patients, except for one who had an allergic reaction, completed the treatment regimens. Fifty to sixty percent of the patients had no side effects while the rest had mild to moderate side effects. The new quadruple therapy consisting of omeprazole, amoxicillin, metronidazole, and roxithromycin appears suitable for use in clinical practice, as the cure rate was 95% and no severe side effects were observed. Pretreatment with omeprazole did not reduce the cure rate for this new quadruple therapy. (Received Sept. 29, 1997; accepted Jan. 23, 1998)     

A short-term eradication therapy for Helicobacter pylori acute gastritis

BACKGROUND AND AIMS: Acute gastritis, caused by an initial infection of Helicobacter pylori (H. pylori), may resolve spontaneously, but the infection sometimes becomes chronic. We examined the efficacy of a short-term H. pylori eradication therapy on acute gastritis. METHODS: Among the 15 patients with hemorrhagic acute gastritis who were randomly allocated to group A (eradication therapy) or group B (Lansoprazole, LPZ), 10 of them started to receive treatment within 1 day after the disease onset. The other five patients began the eradication therapy 4-6 days after disease onset (group C). Eradication therapy consisted of a daily oral administration of each of 30 mg lansoprazole (LPZ), once a day; 400 mg clarithromycin, twice a day; 1000 mg amoxicillin, twice a day; and 300 mg rebamipide, three times a day, for one week. If the endoscopy was normal, medication was stopped for the following 4 weeks before gastric endoscopy was performed again in order to assess H. pylori eradication. RESULTS: All group A patients were cured after the 1-week treatment and therefore, they became H. pylori negative. Group B and C patients had erosions or ulcers after the 1-week treatment and so received an additional 3-week administration of LPZ. Four weeks later, their gastritis was cured and except for one group B patient, they became H. pylori-negative. CONCLUSION: In patients with acute gastritis, caused by an initial H. pylori infection, eradication therapy was efficacious in achieving early healing. This therapy should be started as soon as possible after disease onset.     

益生菌在根除幽门螺杆菌治疗中的作用

幽门螺杆菌(Helicobacter pylori,H.pylori)感染与上胃肠道疾病密切相关。由于H.pylori对抗生素耐药率的增加及根除治疗过程中不良反应的出现,导致标准三联疗法H.pylori根除率逐渐下降。益生菌辅助治疗H.pylori感染已取得一些成果,其在提高H.pylori根除率、降低不良反应中的作用日益受到重视。在H.pylori根除治疗中何时加用益生菌、加用何种益生菌成为国内外研究的热点,益生菌的疗效很大程度上依赖于菌种或菌株类型。益生菌还具有维持胃肠道微生态的稳定、减轻黏膜炎症反应等多种作用,本文对益生菌在根除H.pylori治疗中的作用机制及临床意义、益生菌在降低H.pylori治疗相关不良反应中的作用作一概述。     

Efficacy and safety of modified tetracycline dosing in a quadruple therapy for Helicobacter pylori: A retrospective single center study

BACKGROUND Although highly effective as a component of Helicobacter pylori(H. pylori) treatment regimen, tetracycline is associated with a high incidence of medicationrelated adverse events. Modified dosing of tetracycline as part of quadruple therapy may improve safety while providing comparable eradication rates.AIM To evaluate the efficacy and safety of modified dosing of tetracycline in patients receiving tetracycline and furazolidone-containing quadruple therapy in patients with H. pylori i...     

气囊扩张和根除幽门螺杆菌治疗幽门梗阻

目的 前瞻性观察经内镜气囊扩张和根除Hp对十二指肠球部溃疡并幽门梗阻预后的影响。方法 十二指肠球部溃疡并幽门梗阻用TTS气囊扩张,Hp感染用尿素酶、组织学和血抗体测定,根除Hp用^14C尿素呼气试验。结果 21例均成功经内镜气囊扩张而无并发症,最后气囊直径：12mm10例,15mm8例,18mm3例,4例需重复扩张者为严重狭窄。18例（85.7%)诊断为可能有Hp感染,而行1周四根除细菌治疗,平均随访13月,无复发。余3例未行根除者中2例短期内复发而行外科切除,1例服抑酸剂无复发。结论 气囊扩张和根除Hp治疗对十二指肠球部溃疡并幽门梗阻有较好的效果。     

Helicobacter pylori eradication in the Swedish population

Objectives: Helicobacter pylori is associated with peptic ulcers and gastric cancer and its eradication aims to prevent these conditions. The recommended eradication regimen is triple therapy, consisting of a proton-pump inhibitor in combination with clarithromycin and amoxicillin or metronidazole for 7 days. Yet, other antibiotic regimens are sometimes prescribed. We aimed to assess the use of eradication therapy for H. pylori in the Swedish population during the last decade.

Materials and methods: This population-based study used data from the Swedish Prescribed Drug Register. From July 2005 until December 2014, all regimens that can eradicate H. pylori were identified and evaluated according to patients’ age and sex and calendar year of eradication.

Results: We identified 157,915 eradication episodes in 140,391 individuals (53.8% women, 42.6% older than 60 years), who correspond to 1.5% of the Swedish population. The absolute number and incidence of eradications decreased over the study period. Overall, 91.0% had one eradication and 0.1% had more than three. Of all eradications, 95.4% followed the recommended regimen, while 4.7% did not. The latter group was overrepresented among individuals aged ≥80 years (7.8%). Amoxicillin and clarithromycin were most frequently prescribed, while metronidazole was rarely used (0.01%). Other prescribed antibiotics were ciprofloxacin (2.4%), doxycycline (1.4%), nitrofurantoin (0.7%), norfloxacin (0.5%) and erythromycin (0.3%).

Conclusions: During the last decade in Sweden H. pylori eradication has been frequently prescribed, but the incidence of eradication has slowly declined. Most eradications followed the recommended regimen, including those occurring after a previous eradication.