埃索美拉唑
左氧氟沙星
医学
阿莫西林
内科学
质子抑制剂泵
胃肠病学
幽门螺杆菌
药物治疗
意向治疗分析
联合疗法
不利影响
外科
抗生素
微生物学
生物
作者
Ping‐I Hsu,Feng-Woei Tsai,Shu‐Ching Kao,Wen‐Hung Hsu,Jin‐Shiung Cheng,Nan‐Jing Peng,Kuo‐Wang Tsai,Huang‐Ming Hu,Yao‐Kuang Wang,Seng‐Kee Chuah,Angela Chen,Deng‐Chyang Wu
摘要
Objectives: Proton pump inhibitor (PPI)–amoxicillin–fluoroquinolone triple therapy is recommended as a second-line treatment ofHelicobacter pyloriinfection in the Maastricht V/Florence Consensus Report. However, the eradication rate of this standard salvage treatment is suboptimal. The objective of this study is to compare the efficacy of esomeprazole–bismuth–tetracycline–levofloxacin therapy (TL quadruple therapy) and esomeprazole–amoxicillin–levofloxacin triple therapy (AL triple therapy) in rescue treatment forH. pyloriinfection. Methods: ConsecutiveH. pylori-infected subjects after failure of first-line therapies were randomly allocated to receive either TL quadruple therapy (esomeprazole 40 mg b.d., bismuth 120 mg q.d.s., tetracycline 500 mg q.d.s., and levofloxacin 500 mg o.d.) or AL triple therapy (esomeprazole 40 mg b.d., amoxicillin 500 mg q.d.s., and levofloxacin 500 mg o.d.) for 10 days.H. pyloristatus was assessed 6 weeks after the end of treatment. Results: The study was stopped after an interim analysis. Of 50 patients in the TL quadruple therapy, 49 (98.0%) had successful eradication ofH. pyloriinfection. Cure ofH. pyloriinfection was achieved in 36 of 52 patients (69.2%) receiving AL triple therapy. Intention-to-treat analysis demonstrated that TL quadruple therapy achieved a markedly higher eradication rate than AL triple therapy (difference: 28.8%; 95% confidence interval: 15.7% to 41.9%;P<0.001). Per-protocol analysis yielded a similar result (97.8% vs. 68.6%;P<0.001). The two treatment groups exhibited comparable frequencies of overall adverse events (22.0% vs. 11.5%) and drug compliance (90.0% vs. 98.1%). The subgroup analysis showed that TL quadruple therapy was superior to AL triple therapy in patients with failure of either standard triple therapy (100% vs. 75.0%;P=0.010) or non-bismuth quadruple therapy (95.0% vs. 52.6%;P=0.003). Conclusions: Ten-day PPI–bismuth–tetracycline–levofloxacin quadruple therapy is a good option for rescue treatment ofH. pyloriinfection following failure of standard triple or non-bismuth quadruple therapy.
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