One week triple therapy for Helicobacter pylori:: a multicentre comparative study

被引:151
作者
Misiewicz, JJ
Harris, AW
Bardhan, KD
Levi, S
O'Morain, C
Cooper, BT
Kerr, GD
Dixon, MF
Langworthy, H
Piper, D
机构
[1] Cent Middlesex Hosp, London NW10 7NS, England
[2] Rotherham Dist Hosp, Rotherham, S Yorkshire, England
[3] Northwick Pk Hosp & Clin Res Ctr, Slough, Berks, England
[4] Meath Hosp, Dublin, Ireland
[5] Royal Shrewsbury Hosp, Shrewsbury, Salop, England
[6] Gen Infirm, Leeds LS1 3EX, W Yorkshire, England
[7] Lederle Labs, Gosport, Hants, England
[8] Royal Hosp, Birmingham, W Midlands, England
关键词
eradication; Helicobacter pylori; lansoprazole; omeprazole; metronidazole resistance;
D O I
10.1136/gut.41.6.735
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background-Eradication of Helicobacter pylori cures and prevents the relapse of duodenal ulceration and also results in histological resolution of chronic active gastritis. Aim-To compare four treatment regimens lasting seven days of a proton pump inhibitor and two antibiotics in the eradication of H. pylori. Patients-Men or women with H pylori positive duodenal ulceration or gastritis, or both. Methods-A single blind, prospectively randomised, parallel group, comparative, multicentre study. After a positive CLO test, patients underwent histology, H pylori culture, and a C-13 urea breath test to confirm H pylori status. Treatment with one of four regimens: LAC, LAM, LCM, or OAM, where L is 30 mg of lansoprazole twice daily, A is 1 g of amoxycillin twice daily, M is 400 mg of metronidazole twice daily, C is 250 mg of clarithromycin twice daily, and O is 20 mg of omeprazole twice daily, was assigned randomly. A follow up breath test was done at least 28 days after completing treatment. Results-H pylori eradication (intention to treat) was 104/121 (86.0%) with LAC, 87/131 (66.4%) with LAM, 103/118 (87.3%) with LCM, and 94/126 (74.6%) with OAM. There was a significant difference (p < 0.001) in the proportion of patients in whom eradication was successful between LAC and LCM when compared with LAM, but no significant difference (p = 0.15) between LAM and OAM. Metronidazole resistance before treatment was identified as a significant prognostic factor with regard to eradication of H pylori. The regimens which contained metronidazole were significantly less effective than those without metronidazole in the presence of pretreatment resistant H pylori. There was no difference among the treatment groups with regard to the incidence and severity of adverse events reported. Conclusions-All four treatment regimens were safe and effective in eradicating H pylori in the patient population studied. LAC was the most efficacious treatment in patients with pretreatment metronidazole resistant H pylori, and was significantly better than LAM and OAM in this group of patients.
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页码:735 / 739
页数:5
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