Treatment choices in young patients with Helicobacter pylori infection: Standard triple or bismuth-based quadruple therapies

Yıl 2014, Cilt: 13 Sayı: 2, 57 - 62, 01.08.2014

Nurten Savaş

Öz

Background and Aims:Helicobacter pylori is the most abundant pathogen in all age groups worldwide, and eradication rates of this pathogen are decreasing over time. We aimed to determine the efficacy rates of standard triple and bismuth-based quadruple therapies in young patients with dyspepsia, and in the event of eradication failure, to assess the success rates of rescue treatments with bismuthbased quadruple or levofloxacin-based triple protocols. Materials and Methods:A total of 116 Helicobacter pylori -positive young patients (≤35 years old) with dyspepsia were given either lansoprazole 30 mg bid, amoxicillin 1 g bid, and clarithromycin 500 mg bid for 14 days or bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid for 14 days. In case of eradication failure, levofloxacin, amoxicillin, and lansoprazole or bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid therapies were given as rescue treatments. Results:Helicobacter pylori eradication rates were 85.7% in the bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid group and 63.3% in the lansoprazole 30 mg bid, amoxicillin 1 g bid, and clarithromycin 500 mg bid group. Smoking, alcohol, and nonsteroidal antiinflammatory drug use had no effect on response; the only factor affecting the response rate was bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid treatment. The nonresponder patients in the lansoprazole 30 mg bid, amoxicillin 1 g bid, and clarithromycin 500 mg bid group and bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid groups were given bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid and levofloxacin, amoxicillin, and lansoprazole rescue treatments, respectively, and a 70% success rate was achieved in both groups. Conclusions:Even in young patients, who are supposed to be susceptible to clarithromycin-based treatment, the Helicobacter pylori eradication rates were lower with lansoprazole 30 mg bid, amoxicillin 1 g bid, and clarithromycin 500 mg bid treatment; thus, bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid protocol should be preferred as first-line treatment. There was no difference between the second-line treatment response rates of levofloxacin, amoxicillin, and lansoprazole and bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid protocols

Anahtar Kelimeler

Helicobacter pylori, dyspepsia, triple treatment, quadruple treatment, bismuth, clarithromycin, levofloxacin

Helicobacter pyloriinfeksiyonlu genç hastalarda tedavi seçenekleri; Standard üçlü veya bismuth bazlı dörtlü tedavi

Öz

Giriş ve Amaç: Helicobacter pylori dünyada tüm yaş gruplarında en sık görülen gastrik patojen olup bu patojenin eradikasyon oranları gün geçtikçe azalmaktadır. Bu çalışmanın amacı dispepsisi olan Helicobacter pylori pozitif genç hastalarda standard üçlü ve bizmut bazlı dörtlü tadavilerin başarı oranlarını belirlemek ve tedaviye cevapsızlık durumunda levofloksasin bazlı üçlü ve yine bizmut bazlı dörtlü ikinci basamak tedavilerinin başarı oranlarını saptamaktır. Gereç ve Yöntem: Otuz beş yaş altı 116 Helicobacter pylori pozitif dispepsili hasta çalışmaya alındı. Hastalar iki gruba ayrıldı bir gruba lansoprazol 30 mg bid, amoksisilin 1 gr bid, klaritromisin 500 mg bid 14 günlük tedavi diğer gruba bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid 14 günlük tedavi olarak verildi. Tedaviye yanıtsız olgulara, levofloksasin, amoksisilin, lansoprazol veya bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid tedavileri ikinci basamak tedavi olarak verildi. Bulgular: Helicobacter pylori eradikasyon oranları bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid grubunda %85.7 ve lansoprazol 30 mg bid, amoksisilin 1 gr bid, klaritromisin 500 mg bid grubunda %63.3 bulundu. İstatistiksel olarak sigara, alkol ve nonsteroid-antiinflamatuvar kullanımının tedavi cevabı üzerinde hiçbir etkisi bulunmaz iken tedaviyi etkileyen tek faktörün bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid tedavi seçeneği olduğu belirlendi. Tedaviye yanıtsızlarda ikinci basamak tedavi olarak lansoprazol 30 mg bid, amoksisilin 1 gr bid, klaritromisin 500 mg bid grubunda olanlara bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid ve bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid grubunda olanlara levofloksasin, amoksisilin, lansoprazol tedavisi verildi, her iki grupta da ikinci basamak tedavi ile %70 oranında başarı elde edildi. Sonuç: Klaritromisine duyarlı olmasını beklediğimiz genç hastalarda dahi Helicobacter pylori eradikasyon oranları lansoprazol 30 mg bid, amoksisilin 1 gr bid, klaritromisin 500 mg bid grubunda düşük olup bu hastalarda da bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid tedavisi ilk basamak tedavi olarak düşünülmelidir. İlk basamak tedaviye yanıtsız gençlerde ikinci basamak tedavi seçeneklerinden bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid ve levofloksasin, amoksisilin, lansoprazol arasında fark olmadığı saptanmıştır.

Anahtar Kelimeler

Helicobacter pylori, dispepsi, üçlü tedavi, dörtlü tedavi, bizmut, klaritromisin, levofloksasin

Kaynakça

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