■更新的2016年幽门螺杆菌共识指南建议合并治疗14天(质子泵抑制剂(PPI)-阿莫西林-甲硝唑-克拉霉素(PAMC)或基于铋的四联疗法(PPI-铋-甲硝唑-四环素,PBMT))作为第一行,PBMT或PPI-阿莫西林-左氧氟沙星(PAL)作为第二或三线,以PPI-阿莫西林-利福布汀(PAR)为第4行,持续10天。
这是一项回顾性队列研究,旨在描述和比较2007-2015年和2016-2021年期间抗螺杆菌治疗方案的疗效以及抗生素耐药性。
■使用改良的意向治疗(mITT)分析来分析治疗的成功率。mITT包括所有接受幽门螺杆菌治疗并至少进行过一次随访治愈试验的患者。这包括不能完成治疗或不坚持治疗的患者。通过单因素和多因素logistic回归分析治疗失败的危险因素。在一小部分患者中进行了耐药性测试。
■H.在埃德蒙顿接受治疗的幽门螺杆菌阳性患者,艾伯塔省被纳入mITT分析:2007年至2015年为334/387(86%),2016年至2021年为193/199(97%)。在2016-2021年期间,78%(150/193)的患者接受了基于指南的累积治疗,80%(120/150)的患者成功治愈。在那些新诊断的人中,治愈率为88%(52/59),与以前治疗失败的患者为75%(68/91)(P<0.05,风险差异[RD]14%,95%置信区间[CI]1.7-26.3%)。最有效的一线治疗方案是2016-2021年PAMC14天(87%[45/52])和2007-2015年序贯治疗(83%[66/80])(P=0.535,RD4%,95%CI-8.5-16.5%)。当其他治疗失败时,2007年至2015年,PAR的成功率为50%(2/4),2016年至2021年为57%(21/37)。最近(2016-2021年)对克拉霉素和甲硝唑的耐药率很高,分别为78%(50/64)和56%(29/52),分别。2007年至2015年,克拉霉素和甲硝唑耐药率分别为80%(36/45)和83%(38/46),分别。从2007-2015年到2016-2021年,左氧氟沙星耐药性显着增加(28%[13/46]至61%[35/57],P<0.05,RD33%,95%CI11.6-54.4%)。
■首先使用PAMC和PBMT进行算法处理,PAL,在88%的新诊断患者中,PAR可以治愈幽门螺杆菌。PAR治疗显示欠佳的治愈率(50-57%的成功率),但考虑到左氧氟沙星耐药率的增加,可以认为是第三而不是第四行。幽门螺杆菌中的抗生素耐药性是克拉霉素常见的,甲硝唑,和左氧氟沙星经常导致治疗失败。
UNASSIGNED: Updated 2016 Helicobacter pylori
consensus guidelines recommend treatment for 14 days with concomitant therapy (proton-pump inhibitor (PPI)-amoxicillin-metronidazole-clarithromycin (PAMC) or bismuth-based quadruple therapy (PPI-bismuth-metronidazole-tetracycline, PBMT)) as first line, PBMT or PPI-amoxicillin-levofloxacin (PAL) as second or third line, and PPI-amoxicillin-rifabutin (PAR) as fourth line for 10 days.
UNASSIGNED: This was a retrospective cohort study to describe and compare the efficacy of anti-Helicobacter treatment regimens over the periods 2007-2015 and 2016-2021 as well as antibiotic resistance.
UNASSIGNED: A modified intention-to-treat (mITT) analysis was used to analyze the success rate of therapies. mITT includes all patients who were prescribed H. pylori treatment and had at least one follow-up test-of-cure. This included patients who could not complete treatment or were non-adherent with treatment. Risk factors for treatment failures were analyzed by univariate and multivariate logistic regression. Resistance testing was done in a small subset of patients.
UNASSIGNED: H. pylori-positive patients who received treatment in Edmonton, Alberta were included in a mITT analysis: 334/387(86%) from 2007 to 2015 and 193/199 (97%) from 2016 to 2021. During 2016-2021, 78% (150/193) of patients underwent cumulative
guideline-based treatment with a successful cure in 80% (120/150) of patients. In those who were newly diagnosed, the cure rate was 88% (52/59) versus those with previous treatment failure 75% (68/91) (P < 0.05, risk difference [RD] 14%, 95% confidence interval [CI] 1.7-26.3%). The most effective first-line regimens were PAMC for 14 days (87% [45/52]) in 2016-2021 and sequential therapy in 2007-2015 (83% [66/80]) (P = 0.535, RD 4%, 95% CI -8.5-16.5%). When other treatments failed, success with PAR was 50% (2/4) from 2007 to 2015 and 57% (21/37) from 2016 to 2021. Recent (2016-2021) resistance rates to clarithromycin and metronidazole are high at 78% (50/64) and 56% (29/52), respectively. From 2007 to 2015, clarithromycin and metronidazole resistance rates were 80% (36/45) and 83% (38/46), respectively. Levofloxacin resistance increased significantly from 2007-2015 to 2016-2021 (28% [13/46] to 61% [35/57], P < 0.05, RD 33%, 95% CI 11.6-54.4%).
UNASSIGNED: Algorithmic treatment with PAMC first line followed by PBMT, PAL, and PAR cures H. pylori in 88% of newly diagnosed patients. PAR therapy shows suboptimal cure rates (50-57% success) but can be considered as third instead of fourth line given increasing levofloxacin resistance rates. Antibiotic resistance in H. pylori is common to clarithromycin, metronidazole, and levofloxacin and frequently accounts for treatment failures.