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【商业翻译】One-Week Triple Therapy Sufficient for H py
NEW YORK (Reuters Health) Apr 06 - To eradicate Helicobacter pylori, 1 week of omeprazole, amoxicillin and clarithromycin is as effective as 2 weeks of triple therapy, according to a study conducted in Italy.
"Triple therapy is recommended for Helicobacter pylori eradication, yet consensus on the duration of treatment is lacking," the study team notes in the April issue of the journal Gut. "European guidelines indicate that triple therapy for 1 week is acceptable whereas, in the USA, 10-14 days of treatment is still preferred."
To investigate, Dr. Franco Bazzoli from the University of Bologna and colleagues randomly assigned 909 H pylori-positive patients with duodenal ulcer to 1 or 2 weeks of omeprazole, amoxicillin, and clarithromycin, or to 2 weeks of omeprazole and amoxicillin.
Eradication rates, assessed histologically and by carbon-13 urea breath testing 4 weeks post-treatment, were similar with 1-week of triple therapy and 2-weeks of triple therapy, the team reports.
In intention-to-treat analyses, eradication rates were 79.7% and 81.7% with 1-week and 2-week triple therapy, respectively. In per protocol analyses, eradication rates were 83.6% and 84.9%, respectively.
Both triple-drug regimens yielded significantly higher eradication rates compared with the 2-week 2-drug regimen (44.6% for intention-to-treat and 42.8% for per protocol).
"The tolerability of triple therapy was good and similar for both 1- and 2-week regimens and was not significantly different from double therapy," the authors point out. Poor compliance rates were 18.6%, 17.3%, and 15.1%, respectively, and adverse event occurred in 9.9%, 9.6%, and 5.9%, respectively.
This study, Dr. Bazzoli and colleagues conclude, shows that extending triple therapy from 1 week to 2 weeks does not enhance H pylori eradication rates. In their opinion, 1 week of triple therapy "remains the recommended first line treatment for H pylori eradication."
They also mention that the eradication rates achieved in this study are similar to those of other recent studies and indicate that the efficacy of triple therapy for eradication of H pylori has waned in recent years.
"An increase in the prevalence of clarithromycin resistance seems to the most important cause of this reduced efficacy," the investigators write. "Novel agents and new and modified eradication regimens have been reported to improve eradication rates, but their efficacy still needs confirmation."
Gut 2007;56:475-479.
截稿日期：本星期四晚10点
本稿件为《医师报》约稿，署名统一为“丁香”，稿酬按照医师报标准发放。 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 三联一周方案足以根治幽门螺杆菌
路透社四月六日纽约报道——四月份出版的《消化道》杂志刊载的意大利的一项研究报道，在根治幽门螺杆菌（H.P）治疗中，奥美拉唑、阿莫西林、克拉霉素三联1周方案同2周一样有效。该研究团队撰文：“三联方案被推荐为H.P根治疗法，但其疗程尚未统一。欧洲指南认为一周的疗程是可以接受的，但在美国则更为推崇10－14天的疗程”。在该研究中，来自Bologna大学的Franco Bazzoli医生及其同事将909例H.P阳性的十二指肠溃疡患者随机分入奥美拉唑＋阿莫西林＋克拉霉素三联1周组、2周组及奥美拉唑＋阿莫西林两联2周组。治疗4周后，据组织学检查和碳－13尿素呼吸试验评估H.P是否根治。结果显示，三联方案1周组同三联方案2周组根治率相似。以意向治疗分析，三联方案1周组和2周组的根治率分别为79.7% 和 81.7%；以完成治疗分析，两者根治率分别为83.6% 和 84.9%。两个三联方案的H.P根治率均显著高于两联两周方案（其意向治疗根治率为44.6%，完成治疗根治率为42.8%）。三联方案耐受性良好，1、2周方案相似，同两联方案比较也无显著性差异。三者不良依从率分别为18.6%、17.3%、15.1%。不良反应发生率分别为9.9%、9.6%、5.9%。研究认为，将三联方案的疗程从1周延长至2周并不能增加H.P的根治率。故而，三联一周方案仍应推荐为H.P根治的一线方案。文中也注意到，该研究中的根治率同近期其他研究结果相似，说明三联方案对H.P根治的有效率近年有所下降。H.P根治率下降最为重要的原因可能是克拉霉素耐药率的不断增加。已有报道，新的药物和新的改良根治方案可提高根治率，但其疗效尚有待证实。（Gut 2007;56:475-479）
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作者:admin@医学,生命科学 2010-11-29 17:13
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