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Intern Med J:难治性幽门螺杆菌感染:基于左氧氟沙星的三联治疗可委以重任

2017-07-24 吴刚 环球医学

一线幽门螺杆菌根除失败是一种常见并且具有挑战性的问题。2017年7月,发表在《Intern Med J.》的一项研究对澳大利亚难治性幽门螺杆菌感染患者进行基于左氧氟沙星的三联治疗的前瞻性评估。



一线幽门螺杆菌根除失败是一种常见并且具有挑战性的问题。2017年7月,发表在《Intern Med J.》的一项研究对澳大利亚难治性幽门螺杆菌感染患者进行基于左氧氟沙星的三联治疗的前瞻性评估。

目的:旨在评估澳大利亚基于左氧氟沙星的抢救性三联治疗的有效性。

方法:既往治疗失败后的前瞻性患者被处方埃索美拉唑40mg、阿莫西林1g和左氧氟沙星500mg,每天两次共10天。所有患者都收到了详细的书面和口头的依从性支持。通过13C尿素呼气试验和/或组织学和尿素酶试验评估结局。

结果:150名连续评估的患者(66%为女性,平均年龄54±14岁,吸烟者6人)中,治疗的主要指征为消化性溃疡(17%)、胃癌风险增加(20%)、症状(35%)和其他风险的降低(28%)。既往治疗的中位数为2(范围,1~7)。意愿治疗(ITT)人群的90%实现了幽门螺杆菌根除,按方案人群(PP)根除率为91%。不同既往治疗类型或数量间,根除率没有差异:既往治疗次数≤2(107人)vs既往治疗次数为3或更多(43人):93% vs 84%(P=0.13),年龄、种族或治疗指征间也无差异,但是女性的根除率较高(ITT:94% vs 82%,P=0.04)。依从率较好(95%)。无严重不良事件,11%的患者表示轻度不良反应。20个同时服药病例未观察到原发性左氧氟沙星耐药。

结论:基于左氧氟沙星的三联治疗的有效性和安全性表明,该方案可作为该领域的抢救性治疗方案。不太可能进行随机比较试验,但是这些数据可以与其他抢救性治疗的部分数据相媲美。

原始出处:

Katelaris PH and Katelaris AL. A prospective evaluation of levofloxacin-based triple therapy for refractory Helicobacter pylori infection in Australia. Intern Med J. 2017 Jul;47(7):761-766. doi: 10.1111/imj.13432.

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    2017-11-22 kcb069
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    2017-07-26 freve
  5. [GetPortalCommentsPageByObjectIdResponse(id=1811723, encodeId=71fe1811e23f3, content=<a href='/topic/show?id=751f8889423' target=_blank style='color:#2F92EE;'>#螺杆菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88894, encryptionId=751f8889423, topicName=螺杆菌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Wed Nov 22 21:14:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1738234, encodeId=3cd71e38234c9, content=<a href='/topic/show?id=cbea19e8944' target=_blank style='color:#2F92EE;'>#三联治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19789, encryptionId=cbea19e8944, topicName=三联治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6bb734392571, createdName=12498768m24(暂无昵称), createdTime=Fri Sep 01 19:14:00 CST 2017, time=2017-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1348708, encodeId=547d1348e08fa, content=<a href='/topic/show?id=cfeb49103af' target=_blank style='color:#2F92EE;'>#幽门螺杆菌感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49103, encryptionId=cfeb49103af, topicName=幽门螺杆菌感染)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Wed Jul 26 03:14:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1528365, encodeId=d9fa152836566, content=<a href='/topic/show?id=74b798601a1' target=_blank style='color:#2F92EE;'>#难治性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98601, encryptionId=74b798601a1, topicName=难治性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1ef11916292, createdName=freve, createdTime=Wed Jul 26 03:14:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1530096, encodeId=ad921530096fe, content=<a href='/topic/show?id=7f7848124f5' target=_blank style='color:#2F92EE;'>#左氧氟沙星#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48124, encryptionId=7f7848124f5, topicName=左氧氟沙星)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=666412016730, createdName=cqlidoudou, createdTime=Wed Jul 26 03:14:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1607865, encodeId=5d76160e865aa, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Wed Jul 26 03:14:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=225810, encodeId=fa0322581099, content=谢谢分享,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Mon Jul 24 13:05:31 CST 2017, time=2017-07-24, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1811723, encodeId=71fe1811e23f3, content=<a href='/topic/show?id=751f8889423' target=_blank style='color:#2F92EE;'>#螺杆菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88894, encryptionId=751f8889423, topicName=螺杆菌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Wed Nov 22 21:14:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1738234, encodeId=3cd71e38234c9, content=<a href='/topic/show?id=cbea19e8944' target=_blank style='color:#2F92EE;'>#三联治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19789, encryptionId=cbea19e8944, topicName=三联治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6bb734392571, createdName=12498768m24(暂无昵称), createdTime=Fri Sep 01 19:14:00 CST 2017, time=2017-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1348708, encodeId=547d1348e08fa, content=<a href='/topic/show?id=cfeb49103af' target=_blank style='color:#2F92EE;'>#幽门螺杆菌感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49103, encryptionId=cfeb49103af, topicName=幽门螺杆菌感染)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Wed Jul 26 03:14:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1528365, encodeId=d9fa152836566, content=<a href='/topic/show?id=74b798601a1' target=_blank style='color:#2F92EE;'>#难治性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98601, encryptionId=74b798601a1, topicName=难治性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1ef11916292, createdName=freve, createdTime=Wed Jul 26 03:14:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1530096, encodeId=ad921530096fe, content=<a href='/topic/show?id=7f7848124f5' target=_blank style='color:#2F92EE;'>#左氧氟沙星#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48124, encryptionId=7f7848124f5, topicName=左氧氟沙星)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=666412016730, createdName=cqlidoudou, createdTime=Wed Jul 26 03:14:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1607865, encodeId=5d76160e865aa, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Wed Jul 26 03:14:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=225810, encodeId=fa0322581099, content=谢谢分享,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Mon Jul 24 13:05:31 CST 2017, time=2017-07-24, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1811723, encodeId=71fe1811e23f3, content=<a href='/topic/show?id=751f8889423' target=_blank style='color:#2F92EE;'>#螺杆菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88894, encryptionId=751f8889423, topicName=螺杆菌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Wed Nov 22 21:14:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1738234, encodeId=3cd71e38234c9, content=<a href='/topic/show?id=cbea19e8944' target=_blank style='color:#2F92EE;'>#三联治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19789, encryptionId=cbea19e8944, topicName=三联治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6bb734392571, createdName=12498768m24(暂无昵称), createdTime=Fri Sep 01 19:14:00 CST 2017, time=2017-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1348708, encodeId=547d1348e08fa, content=<a href='/topic/show?id=cfeb49103af' target=_blank style='color:#2F92EE;'>#幽门螺杆菌感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49103, encryptionId=cfeb49103af, topicName=幽门螺杆菌感染)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Wed Jul 26 03:14:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1528365, encodeId=d9fa152836566, content=<a href='/topic/show?id=74b798601a1' target=_blank style='color:#2F92EE;'>#难治性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98601, encryptionId=74b798601a1, topicName=难治性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1ef11916292, createdName=freve, createdTime=Wed Jul 26 03:14:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1530096, encodeId=ad921530096fe, content=<a href='/topic/show?id=7f7848124f5' target=_blank style='color:#2F92EE;'>#左氧氟沙星#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48124, encryptionId=7f7848124f5, topicName=左氧氟沙星)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=666412016730, createdName=cqlidoudou, createdTime=Wed Jul 26 03:14:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1607865, encodeId=5d76160e865aa, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Wed Jul 26 03:14:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=225810, encodeId=fa0322581099, content=谢谢分享,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Mon Jul 24 13:05:31 CST 2017, time=2017-07-24, status=1, ipAttribution=)]
    2017-07-24 清风拂面

    谢谢分享,谢谢

    0

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