幽门螺杆菌根除治疗失败后的补救治疗

幽门螺杆菌（H.pylori)对抗生素的耐药率上升是导致根除治疗失败率上升的主要原因，对经标准方案根除H.pylori失败的患者有必要进行补救治疗。目的：评估铋剂、质子泵抑制剂（PPI）联用呋喃唑酮和四环素组成的7天四联方案用于根除H.pylori治疗失败后补救治疗的疗效，以及H.pylori耐药对疗效的影响。方法：予35例经含克拉霉素根除H.pylori方案治疗、H.pylori仍为阳性的患者以为期7天的四联治疗：枸橼酸铋钾220mg bid 奥美拉唑20mg bid 呋喃唑酮100mg bid 四环素750mg bid。治疗前取胃窦黏膜活检标本进行快速尿素酶试验、组织学检查和培养检测H.pylori。用琼脂扩散法测定克拉霉素、呋喃唑酮和四环素的最低抑菌浓度（MIC）。治疗结束后至少4周，采用^13C-尿素呼气试验进行H.pylori感染状态评估。结果：33例患者完成治疗和随访，2例失访。根据意图治疗（ITT）和试验方案（PP）分析，该补救方案的H.pylori根除率分别为68．6％（24／35）和72．7％（24／33）。10例（28．6％）患者发生轻度副反应（9例发生恶心、中上腹不适，1例发生皮疹）。35例中有27例H.pylori培养成功，克拉霉素的耐药率为51．8％（14／27），呋喃唑酮为3．7％（1／27），四环素为7．4％（2／27）。各药物耐药菌株和敏感菌株的H.pylori根除率无显著差异。结论：铋剂、PPI联用呋喃唑酮和四环素组成的7天联方案作为根除H.pylori治疗失败后的补救治疗可获得较高的H.pylori根除率。

Rescue Therapy for Treatment Failure of Helicobacter pylori Infection

Background: The rising prevalence of antimicrobial resistance of Helicobacter pylori (H. pylori) is the major cause of increasing failure rate of anti-H. pylori therapy. It is necessary to apply rescue therapy to patients who failed to respond to standard therapy. Aims: To assess the efficacy of 7-day quadruple therapy with bismuth, proton pump inhibitor (PPI), furazolidone and tetracycline as rescue therapy for the treatment failure of H. pylori infection and to evaluate the influence of H. pylori resistance on treatment outcome. Methods: Thirty-five patients who entered the clinical trial, failed in first-line treatment of H. pylori infection with clarithromycin-containing regimens, which was proved by endo-scopy-based tests (rapid urease test, histology and/or culture), and received the quadruple regimen: colloidal bismuth subcitrate 220 mg bid, omeprazole 20 mg bid, furazolidone 100 mg bid and tetracycline 750 mg bid for 7 days. The minimal inhibitory concentration (MIC) of clarithromycin, furazolidone and tetracycline were determined by agar dilution methods. At least four weeks after completion of the quadruple therapy, the 13C-urea breath test was performed to evaluate the success of H. pylori eradication. Results: Thirty-three patients completed the treatment courses and were followed-up, only two dropped out. By intention-to-treat (ITT) analysis and per-protocol (PP) analysis, the rates of eradication of H. pylori by the quadruple therapy were 68.6% (24/35) and 72.7% (24/33), respectively. Ten (28.6%) patients had mild side effects (9 nausea and epigastric discomfort, 1 skin rash). H. pylori was cultured successfully in 27 of 35 cases; the rates of resistance of H. pylori to clarithromycin, furazolidone and tetracycline were 51.8% (14/27), 3.7% (1/27) and 7.4% (2/27), respectively. There were no significant differences between antibiotic-resistant and antibiotic-sensitive strains in the eradication rates of H. pylori infection. Conclusions: Quadruple regimen with bismuth, PPI, furazolidone and tetracycline for 7 days as rescue therapy is a promising option for treatment failure of H. pylori infection.