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背景: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220 mg bid+奥美拉唑20 mg bid+呋喃唑酮100 mg bid+四环素750 mg 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?
BACKGROUND: An increase in the rate of antibiotic resistance to H. pylori is the leading cause of the failure rate of eradication therapy, necessitating remedial treatment in patients who have failed the standard regimen of eradication of H. pylori. OBJECTIVE: To evaluate the efficacy of a 7-day quadruple regimen consisting of bismuth and proton pump inhibitors (PPI) in combination with furazolidone and tetracycline for the eradication of salvage therapy after failed H.pylori treatment and the impact of H. pylori resistance on the efficacy. METHODS: Thirty-five patients treated with clarithromycin-containing H.pylori regimen and patients who remained positive for H.pylori were treated with four-day treatment for 7 days: bismuth potassium citrate 220 mg bid + omeprazole 20 mg bid + furazolidone 100 mg bid + tetracycline 750 mg bid. Antral mucosa biopsy specimens were taken before treatment for rapid urease test, histological examination and culture to detect H.pylori. The minimum inhibitory concentration (MIC) of clarithromycin, furazolidone and tetracycline was determined by agar diffusion method. At least 4 weeks after the end of treatment, the 13C-urea breath test was used to evaluate the H. pylori infection status. Results: 33 patients completed the treatment and follow-up, 2 patients lost. According to ITT and PP analysis, the H.pylori eradication rates for this remediation program were 68.6% (24/35) and 72.7% (24/33), respectively. Mild side-effects occurred in 10 (28.6%) patients (nausea in 9, mid-upper abdomen discomfort, and rash in 1). Among the 35 cases, 27 cases were successfully cultured with H.pylori. The rates of resistance to clarithromycin were 51.8% (14/27), 3.7% (1/27) for furazolidone and 7.4% (2/27) for tetracycline. There was no significant difference in H.pylori eradication rates between drug-resistant and susceptible strains. Conclusion: bismuth, PPI combined with furazolidone?