Are first-line Helicobacter pylori eradication therapies alarming?

Yıl 2009, Cilt: 8 Sayı: 2, 59 - 62, 01.08.2009

A. Ferit Erdoğan Kutlu Abacı Ender Serin Birol Özer M. Okan İçer

Öz

Background and Aims: We aimed to assess the efficacy of four different eradication therapies (first-line) in non-ulcer dyspeptic patients in a gastroenterology polyclinic. Materials and Methods: The file information of 248 patients was examined retrospectively. These patients had been diagnosed as non-ulcer dyspepsia via endoscopy. They tested positive for Helicobacter pylori and received eradication therapy for two weeks. Subsequently, they were monitored using the C14 urea breath test after 4-6 weeks. Four first-line eradication therapy regimes were used as follows: Group LAC (n: 114): Lansoprazole 2x30 mg, amoxicillin 2x1000 mg, clarithromycin 2x500 mg; Group LACB (n: 62): Lansoprazole 2x30 mg, amoxicillin 2x1000 mg, clarithromycin 2x500 mg, bismuth subcitrate 4x300 mg; Group PLA (n: 43): proton pump inhibitor (PPI) (standard dose) 2x1, levofloxacin 1x500 mg, amoxicillin 2x1000 mg; Group PBTM (n: 29): PPI (standard dose) 2x1, bismuth subcitrate 4x300 mg, tetracycline 4x500 mg, metronidazole 3?500 mg. Results: The eradication rates were as follows: Group LAC 52.6%, Group LACB 59.7%, Group PLA 60.5%, and Group PBTM 72.4%. The difference in eradication rates between groups was not statistically significant (p=0.261). Conclusions: The resistance of H. pylori to antibiotics is a significant problem. Current H. pylori therapies should be revised and new studies should be conducted.

Anahtar Kelimeler

Helicobacter pylori, eradication therapy, clarithromycin, amoxicillin, levofloxacin, metronidazole, tetracycline, bismuth subcitrate

Birinci tercih Helikobakter pilori eradikasyon tedavileri alarm mı veriyor?

Öz

Amaç: Helikobakter pilori pozitif nonülser dispepsili hastalarda birinci tercih dört farklı eradikasyon tedavi protokolünün etkinliğinin değerlendirilmesi Gereç ve Yöntem : Gastroenteroloji polikliniğinde endoskopi ile Helikobakter pilori (+) nonülser dispepsi tanısı konan, daha önce eradikasyon tedavisi almamış hastaların dosya bilgileri retrospektif olarak incelendi. 14 günlük eradikasyon tedavisi verilen ve tedavinin bitiminden 4-6 hafta sonra 14C üre nefes testi kontrolü yapılan 248 hastanın dosya bilgisi kaydedildi. Birinci tercih eradikasyon tedavi protokolleri dört gruba ayrıldı. Bunlar; Grup LAK: Lansoprazol 2x30 mg, amoksisilin 2x1000 mg, klaritromisin 2x500 mg Grup LAKB: Lansoprazol 2x30 mg, amoksisilin 2x1000 mg, klaritromisin 2x500 mg, bizmuth subsitrat 4x300 mg Grup PLA: Proton pompa inhibitörü (standart doz) 2x1, levofloksasin 1x500 mg, amoksisilin 2x1000 mg Grup PBTM: Proton pompa inhibitörü (standart doz) 2x1, bizmuth subsitrat 4x300 mg, tetrasiklin 4x500 mg, metronidazol 3x500 mg Bulgular: Grup LAK'da hasta sayısı: 114 ve eradikasyon oranı: %52.6, Grup LAKB'de hasta sayısı: 62 ve eradikasyon oranı: %59.7, Grup PLA'da hasta sayısı: 43 ve eradikasyon oranı: %60.5, Grup PBTM'de hasta sayısı: 29 ve eradikasyon oranı: %72.4 bulundu. Gruplar arasında eradikasyon başarısı açısından istatistiksel olarak anlamlı fark bulunmadı (p=0,261). Sonuç: Antibiyotiklere karşı Helikobakter pilori direnci ciddi bir problem olarak karşımıza çıkmaktadır. Helikobakter pilori tedavilerinin tekrar gözden geçirilmesi ve bu alanda yeni araştırmalara ihtiyaç vardır.

Anahtar Kelimeler

Helikobakter pilori, eradikasyon tedavisi, klaritromisin, amoksisilin, levofloksasin, metronidazol, tetrasiklin, bizmuth subsitrat

Kaynakça

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