埃索美拉唑治疗幽门螺杆菌阳性十二指肠球部溃疡疗效观察

目的：比较埃索关拉唑与兰索拉唑、奥美拉唑三联疗法治疗幽门螺杆菌（Hp）阳性十二指肠球部渍疡疗效观察。方法：将84例Hp阳性的十二指肠球部溃疡随机分为三组。埃索美拉唑组（28例）：埃索美拉唑20mg＋阿莫西林1g＋呋喃唑酮100mg,每日2次,共7日,后服用埃索美拉唑20mg,每日一次,共21天;兰索拉唑组（28例）：兰索拉唑15mg＋阿莫西林1g＋呋喃唑酮100mg,每日2次,共7日,后服用兰索拉唑15mg,每日一次,共21天;奥美拉唑组（28例）：奥美拉唑20mg＋阿莫西林1g＋呋喃唑酮100mg,每日2次,共7日,后服用奥美拉唑20mg,每日一次,共21天。疗效结束4周后复查胃镜并检测Hp,观察腹痛缓解率、溃疡愈合率,Hp根治率及药物不良反应。结果：埃索美拉唑组、兰索拉唑组和奥关拉唑组溃疡愈合率分别为100％,85．7％,82．1％,HP根治率为85．7％,60．7％,64.3％,埃索美拉唑组溃疡愈合率及Hp根除率高于兰索拉唑组及奥美拉唑组,差异具有统计学意义（P〈0．05）。兰索拉唑组及奥美拉唑组溃疡愈合率及Hp根除率无明显差异（P〉0．05）。三组用药后不良反应少,具较好的安全性。结论：埃索关拉唑三联疗法治疗Hp阳性的消化性溃疡疗效优于兰索拉唑及奥美拉唑三联疗法,值得临床广泛应用。     

埃索美拉唑三联疗法治疗复发性消化性溃疡临床对比研究

目的:比较埃索美拉唑三联与奥美拉唑三联疗法治疗幽门螺杆菌(Hp)阳性复发性消化性溃疡的临床疗效.方法:将90例经内镜诊断并检测证实Hp阳性的复发性消化性溃疡患者随机分为两组.A组(45例):埃索美拉唑20 mg 羟氨苄青霉素l g 黄连素300 mg,每日2次,共7 d;B组(45例):奥美拉唑20 mg 羟氨苄青霉素1 g 克拉霉素500 mg,每日2次,共7 d.疗程结束4周后复查胃镜并检测Hp,观察腹痛缓解率、溃疡愈合率、Hp根除率及用药后的不良反应等.结果:埃索美拉唑组第1天和第2天腹痛缓解率分别为34.6%和59.6%,高于奥美拉唑组的17.3%和38.5%(P＜0.05 o埃索美拉唑组和奥美拉唑组溃疡愈合率分别为92-3%和88.5%,Hp根除率分别为88.5%和82.7%,差异无显著性(P＞0.05).两组用药后不良反应少,有较好的安全性.结论:埃索美拉唑三联疗法治疗Hp阳性的复发性消化性溃疡安全有效,腹痛缓解速度优于奥美拉唑三联疗法.     

四联疗法治疗幽门螺杆菌阳性胃溃疡的疗效观察

目的:观察埃索美拉唑联合瑞巴派特、阿莫西林、克拉霉素治疗幽门螺杆菌阳性胃溃疡临床疗效。方法:60例确诊的Hp阳性胃溃疡患者随机分为对照组(30例)和治疗组(30例),其中对照组患者给予奥美拉唑+阿莫西林+克拉霉素三联法治疗,实验组给予埃索美拉唑+瑞巴派特+阿莫西林+克拉霉素四联法治疗。观察比较两组患者临床症状缓解情况,溃疡愈合率、Hp根除率及溃疡复发率。结果:①经过治疗,所有患者腹痛、腹胀、反酸、暧气等临床症状积分均显著降低(P<0.01),且治疗组下降程度大于对照组,两组间差异有统计学意义(P<0.05)。②治疗组患者痊愈率为60.00%、总有效率为93.33%,明显高于对照组痊愈率(43.33%)和总有效率(80.00%),两组间差异有统计学意义(P<0.05)。③治疗组S2期获得率、溃疡愈合率和Hp根除率分别为93.33%、96.67%和93.33%,显著高于对照组60.00%的S2期获得率、70.00%的愈合率和83.33%的根除率(P<0.01或0.05)。④随访1年后,治疗组患者溃疡复发率为11.54%,与对照组32.00%的复发率比较差异有显著性(P<0.05)。结论:四联疗法治疗幽门螺杆菌阳性胃溃疡可有效缓解患者临床症状,提高溃疡愈合质量,根除Hp感染,减少复发,效果优于三联疗法。     

铋剂四联疗法联合双岐三联活菌对Hp感染患者的疗效

为了对比分析2种含铋剂四联疗法联合双岐三联活菌胶囊分别对幽门螺杆菌(Helicobacter pylori,Hp)感染患者疗效的影响。本研究随机选取200例就诊的Hp感染患者,将患者随机分为4组,每组50例。A组(埃索美拉唑,克拉霉素,阿莫西林,枸橼酸铋钾胶囊)、B组(埃索美拉唑,呋喃唑酮,阿莫西林,枸橼酸铋钾胶囊)、C组(埃索美拉唑,克拉霉素,阿莫西林,枸橼酸铋钾胶囊,双歧杆菌三联活菌胶囊)和D组(埃索美拉唑,呋喃唑酮,阿莫西林,枸橼酸铋钾胶囊和双歧杆菌三联活菌胶囊)。分析对比四组患者的临床缓解疗效、幽门螺旋杆菌根除效率、不良反应、复发情况及成本效果比。研究表明:2种含铋剂四联疗法联合双岐三联活菌胶囊对幽门螺杆菌感染患者的临床缓解症状、幽门螺杆菌根除率效果、不良反应发生率和复发情况效果优于含铋剂四联疗法,但是D组成本效果比更具有经济学优势。埃索美拉唑、呋喃唑酮、阿莫西林、枸橼酸铋钾胶囊和双歧杆菌三联活菌胶囊联合可促进Hp患者恢复,根除率高,降低不良反应和复发率,且具有经济学优势,值得推广应用。     

四联疗法治疗幽门螺杆菌阳性胃溃疡的疗效观察

目的：观察埃索美拉唑联合瑞巴派特、阿莫西林、克拉霉素治疗幽门螺杆菌阳性胃溃疡临床疗效。方法：60例确诊的Hp阳性胃溃疡患者随机分为对照组（30例）和治疗组（30例）,其中对照组患者给予奥美拉唑＋阿莫西林＋克拉霉素三联法治疗,实验组给予埃索美拉唑＋瑞巴派特＋阿莫西林＋克拉霉素四联法治疗。观察比较两组患者临床症状缓解情况,溃疡愈合率、Hp根除率及溃疡复发率。结果：①经过治疗,所有患者腹痛、腹胀、反酸、暧气等临床症状积分均显著降低（P〈0.01）,且治疗组下降程度大于对照组,两组间差异有统计学意义（P〈0.05）。②治疗组患者痊愈率为60.00%、总有效率为93.33%,明显高于对照组痊愈率（43.33%）和总有效率（80.00%）,两组间差异有统计学意义（P〈0.05）。③治疗组S2期获得率、溃疡愈合率和Hp根除率分别为93.33%、96.67%和93.33%,显著高于对照组60.00%的S2期获得率、70.00%的愈合率和83.33%的根除率（P〈0.01或0.05）。④随访1年后,治疗组患者溃疡复发率为11.54%,与对照组32.00%的复发率比较差异有显著性（P〈0.05）。结论：四联疗法治疗幽门螺杆菌阳性胃溃疡可有效缓解患者临床症状,提高溃疡愈合质量,根除Hp感染,减少复发,效果优于三联疗法。     

雷贝拉唑三联疗法治疗胃溃疡100例临床疗效治疗

目的:观察雷贝拉唑联用克拉霉素、阿莫西林胶囊治疗良性溃疡疗效.方法:100例良性溃疡病人随机分成治疗组和对照组,治疗组采用雷贝拉唑+克拉霉素+阿莫西林治疗,对照组采用照组用奥美拉唑+克拉霉素+阿莫西林三联疗法,4周后复查胃镜、检测Hp并复查血、尿常规及肝肾功能.结果:治疗组有效率为94％,对照组有效率为80％,两者有显著性差异(P＜0.05);治疗组Hp转阴率为88％,显著高于对照组的转阴率72％(P＜0.05).结论:雷贝拉唑三联疗法治疗胃溃疡疗效高,无明显毒副作用,值得临床推广应用.     

老年幽门螺杆菌相关性消化溃疡的临床特征及治疗方案研究

目的:分析研究老年幽门螺杆菌相关性消化溃疡的临床特征及治疗方案。方法:收集本院收治的240例老年消化性溃疡的患者,检查后按照Hp分组,则Hp阳性组患者206例,Hp阴性组患者36例,比较两组的年龄、溃疡部位、胃泌素和生长抑素水平。之后,将Hp阳性组患者等分为实验组和对照组,每组各103例,实验组给予埃索美拉唑三联疗法,对照组给予奥美拉唑三联疗法,治疗结束后评定临床效果。结果:Hp阳性组年龄和十二指肠溃疡率比Hp阴性组显著高,而胃溃疡率和生长抑素水平显著低(p0.05)。实验组和对照组Hp根除率、溃疡愈合率和不良反应发生率无明显差异(p0.05),但是临床症状消失时间实验组明显短于对照组(p0.05)。结论:老年幽门螺杆菌相关性消化溃疡的患者中,十二指肠溃疡的发病率高与胃溃疡,埃索美拉唑治疗消化性溃疡,临床症状消失快,值得临床推广。     

埃索美拉唑与奥美拉唑治疗老年反流性食管炎的临床疗效及其经济学评价

目的:对比分析埃索美拉唑与奥美拉唑在治疗老年反流性食管炎(RE)的临床疗效及其经济学价值。方法:采用随机数字表法将我院2013年2月至2014年8月消化科门诊治疗的84例老年RE患者分成埃索美拉唑组与奥美拉唑组,每组患者42例。两组患者分别给予埃索美拉唑与奥美拉唑治疗,对比分析两组治疗第4、8周的临床症状和食管炎病变,对治疗方案进行成本(C)-效果(E)分析。结果:两组治疗第8周的临床有效率、食管炎愈合率和总有效率均显著高于第4周(P0.05);其中埃索美拉唑组第4周和第8周的临床有效率均显著高于奥美拉唑组(P0.05);埃索美拉唑组治疗第8周的食管炎愈合率和食管炎总有效率均显著高于奥美拉唑组(P0.05);埃索美拉唑组4周、8周治疗的C/E值均低于奥美拉唑组。结论:埃索美拉唑在治疗老年RE的临床疗效上优于奥美拉唑,且C/E较低,临床上具有较高的经济学价值。     

奥美拉唑与呋喃唑酮及阿莫西林联用治疗幽门螺杆菌阳性十二指肠肠溃疡的疗效观察

目的：观察奥美拉联用呋喃唑酮及阿莫西林治疗幽门螺杆菌(Hp)阳性十二指肠溃疡的临床疗效。方法：对45例经胃镜活检证实的Hp阳性十二指肠溃疡应用奥美拉唑20mg Bid 呋喃唑酮0．2g Bid 阿莫西林1．0g Bid,疗程1w。结果：45例病例中,42例愈合,40例根除,7d疼痛缓解率为87％。结论：呋喃唑酮三联疗法能有效地根除Hp,且不良反应少,疗效高,病人依从性好,价格适中,是较理想的方案,值得进一步尝试。     

香连片联合三联疗法根除十二指肠溃疡患者幽门螺杆菌感染的临床比较研究

目的:通过与短程三联方法比较,观察香连片联合三联疗法根除十二指肠溃疡患者幽门螺杆菌(Hp)感染的根除率和治疗十二指肠溃疡的疗效.方法:120例经胃镜检查确诊为十二指肠溃疡活动期并经快速尿素酶试验和血清杭Hp杭体(ELASE)或病理学检查确定为Hp阳性的患者分为4组:OACX组(奥美拉唑20mg+阿莫西林1000mg+克拉霉素250mg+香连片5片)、OMCX组(奥美拉唑20mg+甲硝唑400mg+克拉霉素250mg+香连片5片),OAC组(奥美拉唑20mg+阿莫西林1OOOmg+克拉霉素250mg)和OMC组(奥美拉唑20mg+甲硝唑400mg+克拉霉素250mg),每日2次,连续7天.然后单独奥美拉唑20mg,每日1次,连续28天,并于用药结束后第28-56天内作13C-尿素呼气试验判断Hp根除率的效果.同时在用药后第1、2、3、7、21和35天对患者的上腹痛、反酸以及上腹烧灼感等症状进行评估.结果:108例患者完成全部治疗方案,12例失访.Hp根除率检查结果显示OACX组的Hp根除率为92.9%(26/28)OMCX组为85.7%(24/28),OAC组为66.7%(18/27)和OMC组为60.0%(15/25).4组间差异有显著性(P<0.01).症状改善情况:4组从用药第1天起均能有效改善患者的上腹痛、反酸、上腹烧灼感等症状,但是,OACX组和OMCX组的总得分下降幅度均显著高于OAC和OMC组(P<0.05-0.01).结论:OACX组和OMCX组对Hp具有相当高的根除率OACX组和OMCX组方案是适合我国国情的根除Hp行之有效的方案,而且,缓解十二指肠溃疡患者的症状,OACX组和OMCX组亦为优.     

Double-Blind, Multicenter Evaluation of Lansoprazole and Amoxicillin Dual Therapy for the Cure of Helicobacter pylori Infection

Background Treatment with amoxicillin plus omeprazole results in disappointing cure rates of Helicobacter pylori infection. The minimal inhibitory concentration of lansoprazole for H. pylori in vitro is lower than that for omeprazole, prompting interest in treatment with amoxicillin plus lansoprazole.
Materials and Methods. H. pylori -infected patients with endoscopically documented duodenal ulcer either currently or within the past year were randomized to 14 days of (1) lansoprazole, 30 mg bid, plus amoxicillin, 1 gm tid; (2) lansoprazole, 30 mg tid, plus amoxicillin, 1 gm tid; (3) lansoprazole, 30 mg tid alone; or (4) amoxicillin, 1 gm tid alone. Endoscopy was done at enrollment and at 4 to 6 weeks after completion of treatment or for recurrent symptoms. H. pylori status was assessed by culture and histology. Ulcer prevalence was evaluated at follow-up endoscopy.
Results. Two hundred sixty-two patients met enrollment criteria and were treated. By per-protocol analysis, H. pylori infection was cured in 57% of those treated with lansoprazole twice daily plus amoxicillin and in 67% of those treated with lansoprazole three times daily plus amoxicillin, compared with 0% treated with lansoprazole alone or amoxicillin alone ( p < .001 for dual therapy versus either monotherapy). Amoxicillin resistance was not observed. At follow-up endoscopy, ulcer prevalence was 17% in patients treated with lansoprazole twice daily plus amoxicillin, 23% in those treated with lansoprazole three times daily plus amoxicillin, 33% in those treated with lansoprazole alone, and 35% in those treated with amoxicillin alone ( p = .024; lansoprazole twice daily plus amoxicillin versus amoxicillin alone).
Conclusions. Treatment with amoxicillin plus lansoprazole, 30 mg tid, led to cure of H. pylori infection in 67% of patients with active or recently healed duodenal ulcer.     

Increased primary resistance to recommended antibiotics negatively affects Helicobacter pylori eradication

Objective. To evaluate the efficacy of two commonly employed treatments for Helicobacter pylori infection and the impact of bacterial resistance to antibiotics on eradication rate. Methods. Ninety‐two consecutive H. pylori‐positive patients with active peptic ulcer disease were randomly enrolled to receive a 7‐day treatment with either lansoprazole 30 mg plus amoxicillin 1 g and clarithromycin 500 mg [all twice a day (b.i.d.), Group A, n = 46]; or bismuth subcitrate 125 mg four times a day (q.i.d.) plus tetracycline 500 mg q.i.d and furazolidone 200 mg b.i.d. (Group B, n = 46) H. pylori status was reassessed 30 days after completion of the therapy and bacterial resistance to the antibiotics was investigated using an in vitro assay. Results. Five patients from each study group were lost to follow up. Both treatments resulted in similar H. pylori eradication rate: 66–60% (per protocol), 59–52% (intention‐to‐treat) in Groups A and B, respectively (non significant). However, eradication improved to 79% in the absence of H. pylori resistance to clarithromycin or amoxicillin. Conclusion. Primary resistance to clarithromycin or amoxicillin may underscore a potentially serious problem for the eradication of H. pylori infection. Testing for bacterial resistance may become necessary to improve therapeutic efficacy.     

Six regimens for the eradication of Helicobacter pylori (Hp) in duodenal ulcer patients: three consecutive trials (1995-1999).

AIM: to present our experience in eradicating Hp in three consecutive trials performed between 1995 and 1999. METHODS: 320 duodenal ulcer outpatients have been enrolled in three open, prospective controlled trials. Hp infection was confirmed by Giemsa stain and Rut. In Trial I, 52 cases received 20 mg omeprazole + 2 x 250 mg clarithromycin + 2 x 500 mg tinidazole (OCT), 48 patients were given 20 mg omeprazole, 2 x 1000 mg amoxicillin + 2 x 500 mg metronidazole (OAM) for 7 days; in Trial II, 48 cases received 40 mg pantoprazole + 2 x 1000 mg amoxicillin + 2 x 500 mg clarithromycin (PAC) for 7 days and 5l cases 2 x 400 mg ranitidin bismuth citrate + 2 x 500 mg clarithromycin for 14 days (RBC-C); in Trial III, 60 cases were treated with 2 x 30 mg lansoprazole + 2 x 250 mg clarithromycin + 2 x 500 mg metronidazole and 6l patients received 2 x 400 mg ranitidin bismuth citrate+2 x 250 mg clarithromycin + 2 x 500 mg metronidazole (RBC-CM). The patients were controlled within 4-6 weeks by endoscopy in trials I-II and 13C-urea breath test in trial III. RESULTS: Eradication rates on ITT/PP basis were: OCT: 72.3/80.2% vs OAM 51.2/63.5% (P = 0.02/P = 0.03); PAC: 80.8/88.3% vs RBC-C 80.3/85.4% (P = 0.65/0.67) and LCM 78.3/92.1% vs RBC-CM 78.7/90.5% (P = 0.86/P = 0.93). Side effects occurred in 5.2, 8.6, 9.5, 14.5, 13.5 and 18.3% of the cases. CONCLUSION: Regimens using 2 x l PPI or RBC + 2 antibiotics for l week proved to be the most effective for Hp eradication in duodenal ulcer patients.     

黄连素四联方案补救治疗幽门螺杆菌感染的有效性和安全性

目的:探索黄连素四联方案用于幽门螺杆菌感染根除失败患者补救治疗的有效性及安全性。方法:将经四联方案初次根除治疗失败并自愿接受补救治疗的130例患者按纳入顺序,以1:1的比例分配治疗,随机接受14天黄连素四联(埃索美拉唑20mg+胶体果胶铋200 mg+阿莫西林1000 mg,2/d+黄连素300 mg 3/d)或四环素四联(埃索美拉唑20 mg+胶体果胶铋200 mg+四环素750 mg+呋喃唑酮100 mg,2/d)方案的治疗。所有患者均于治疗14天及治疗结束至少28天后随诊,详细记录患者症状及不良反应情况。治疗结束至少28天后进行13C尿素呼气试验来判断幽门螺杆菌根除情况。结果:65例接受黄连素四联根除治疗,65例接受四环素四联方案治疗。两组分别有6例和4例患者因不良反应服药依从性小于80%,其余患者均完成了14天的治疗。黄连素组和四环素组的幽门螺杆菌根除率ITT分析分别为76.9%(50/65)和81.5%(53/65),P=0.520;PP分析分别为84.7%(50/59)和86.9%(53/61),P=0.739。黄连素组和四环素组不良事件总体发生率分别为49.2%和41.5%,P=0.370。结论:黄连素四联疗法用于幽门螺杆菌感染的二次根除治疗,根除率较高,未明显增加不良事件发生率,是有效及安全的补救治疗方案。     

Comparative Treatment of Helicobacter pylori–Positive Duodenal Ulcer Using Pantoprazole at Low and High Doses Versus Omeprazole in Triple Therapy

Background. Helicobacter pylori eradication has become the standard treatment for peptic ulcer disease. H. pylori –eradicating triple therapy with omeprazole plus two antibiotics has been used until recently; however, the efficacy of pantoprazole and antibiotics for H. pylori eradication has not been researched thoroughly until now. The aim of this randomized clinical trial was to verify the efficacy of triple oral therapy comparing the effects of pantoprazole using two different doses versus omeprazole twice daily in H. pylori eradication, in ulcer healing and relapses, and in gastritis improvement.
Materials and Methods. We enrolled 243 patients with H. pylori– positive duodenal ulcer and randomized them into three treatment groups: 84 patients (group Ome40) were assigned to receive omeprazole, 20 mg twice daily, plus amoxicillin, 1 gm twice daily, and clarithromycin, 500 mg twice daily for 10 days; 79 patients (group Pan40) were treated with pantoprazole, 40 mg daily, plus amoxicillin and clarithromycin at the same doses as those of group Ome40; and 80 patients (group Pan80) were treated with pantoprazole, 40 mg twice daily, plus amoxicillin and clarithromycin at the same doses as those of group Ome40.
Results. Ulcer healing was observed in 81 of 84 patients (96.4%) in group Ome40; in 66 of 79 patients (83.5%) in group Pan40; and in 77 of 80 patients (96.2%) in group Pan80. H. pylori was eradicated in 79 of 84 patients (94%) in group Ome40; in 63 of 79 patients (79.7%) in group Pan40; and in 75 of 80 patients (93.7%) in group Pan80.
Conclusions. We found that 10-day triple therapy with amoxicillin, clarithromycin, and either pantoprazole, 80 mg daily, or omeprazole, 40 mg daily, is highly effective in ulcer healing and is very well tolerated, achieving the 90% cure recommended for an ideal first-line anti– H. pylori positive duodenal ulcer treatment regimen.     

Fromilide (clarithromycin) in eradication of Helicobacter pylori in patients with duodenal ulcer]

The results of two treatment regimes of duodenal ulcer associated with Helicobacter pylori are presented. The patients of the group I were treated with omeprazole, fromilid (clarithromycin) and metronidazole, the patients of the group II were treated with omeprazole, fromilid (clarithromycin) and furazolidone for 7 days. Then patients of both groups were treated with omeprazole for two weeks. Duodenal ulcer healing was registered for all 10 patients in the group I and for 8 patients (of 10 patients) in the group II. Eradication of H. pylori according to rapid urease test and PCR was confirmed for 9 and 4 patients in the group I and for all 10 patients in the group II.     

Comparison of seven and fourteen days of lansoprazole, clarithromycin, and amoxicillin therapy for eradication of Helicobacter pylori: a report from India

Background. In developed countries, a 1-week regimen of combined proton pump inhibitors and two antibiotics is considered adequate for Helicobacter pylori eradication. However, there is a paucity of reports from developing countries on treatment duration of less than 14 days. We compared efficacy of 7 and 14 days of lansoprazole (L), clarithromycin (C), and amoxicillin (A) combinations for eradication of H. pylori.
Patients and Methods. Forty-six consecutive patients who presented with upper gastrointestinal symptoms and tested positive for H. pylori infection were included in the study. In every patient, after performance of upper gastrointestinal endoscopy, antral biopsies were obtained. H. pylori infection was diagnosed by positive rapid urease test and identification of organisms on antral histology. Patients were randomly selected to receive lansoprazole, 30 mg once daily, plus clarithromycin, 250 mg twice daily, plus amoxicillin, 500 mg three times daily for 2 weeks ( group 1; n = 24; age , 36 ± 12 years ; 18 men ) or 1 week ( group 2; n = 22; age , 45 ± 15 years ; 12 men ). One month after completion of treatment, repeat upper gastrointestinal endoscopy was performed. H. pylori eradication was defined as absence of organism on histopathological examination of both antrum and body of stomach and negative rapid urease test.
Results. Eradication rate was higher in group 1 (23 of 24; 96%) as compared to group 2 (12 of 22; 54%; p < .05). One patient in group 1 had diarrhea, and one patient in group two had skin rash and itching.
Conclusions. Fourteen-day therapy with lansoprazole, clarithromycin, and amoxicillin is highly effective in eradication of H. pylori. Reducing duration of therapy to 7 days significantly lowers eradication rates.     

Quadruple therapy is effective for eradicating Helicobacter pylori after failure of triple proton-pump inhibitor-based therapy: a detailed, prospective analysis of 21 consecutive cases

Background. Data regarding the effectiveness of second-line treatment of Helicobacter pylori infection are limited, especially if microbiological studies are considered.
Methods and Patients. We conducted a prospective, uncontrolled study of a consecutive series of 21 peptic ulcer patients with failure of 1-week lansoprazole, amoxicillin, and clarithromycin. H. pylori status was evaluated by urease test, histology, culture, and urea breath test. Susceptibility to amoxicillin, clarithromycin, and metronidazole was studied by E -test. Cure of infection was defined as negative results from endoscopy-based tests 1 month after treatment and negative results from a urea breath test at 2 months. Treatment consisted of a 1-week combination of lansoprazole (30 mg bid), tetracycline (500 mg qid), metronidazole (500 mg tid), and bismuth subcitrate (120 mg qid).
Results. H. pylori was resistant to metronidazole in three cases, to clarithromycin in three cases, and to both clarithromycin and metroinidazole in an additional three patients. No resistance to amoxicillin was found. Eradication was obtained in 20 cases (95.2% confidence interval [CI], 76.2–99.9). The only patient in whom infection was not eradicated harbored a metronidazole-resistant (minimum inhibitory concentration> 32 μg/ml) strain. No significant side effects were reported.
Conclusion. Quadruple therapy obtains a high eradication rate even in patients with clarithromycin- and metronidazole-resistant strains. Further randomized and controlled studies are warranted and are urgently needed.