Диагностика
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Стандартный 7 дневный режим лечения helicobacter



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d., and 500 mg clarithromycin b.i.d. In the case of penicillin allergy, 500 mg metronidazole b.i.d. is substituted for amoxicillin. When first-line H pylori eradication fails, a second-line treatment of quadruple therapy, with a proton-pump inhibitor b.i.d., colloidal bismuth subcitrate q.i.d., 500 mg metronidazole t.i.d., and 500 mg tetracycline q.i.d, is recommended.

    Antibiotic resistance is the main cause of failure for

H pylori eradication and bata-lactamase produced by resistant H pylori strains is a possible mechanism underlying the ineffectiveness of an amoxicillin-based triple or quadruple therapy[1]. Of the 153 clinical isolates of H pylori found in a previous study, 71.9% are resistant to amoxicillin, 77.8% to metronidazole, and 39.2% to both[2]. The resistance rate to clarithromycin is currently 2%-30%[3]. Consequently, new treatment modalities have recently emerged to overcome antibiotic resistance[4]. However, comprehensive comparisons of the effectiveness of traditional and new treatment modalities are lacking in the literature.

    Antibacterial activities of beta-lactamase inhibitors such as clavulanic acid and sulbactam have been demonstrated in a number of in vitro studies[5,6]. However, using clavulanic acid associated with amoxicillin has not significantly increased the H pylori eradication rate in vivo[7,8]. The aim of this study was to compare the effectiveness of the following therapeutic regimens (triple therapy, standard amoxicillin-based quadruple therapy, ampicillin-sulbactam-based quadruple therapy) in eradicating H pylori in a three-armed randomized clinical trial for the first time.

 

MATERIALS AND METHODS

Patients and medications

A total of 360 H pylori-positive patients suffering from dyspepsia and aging 24-79 years with a median age of 42 years were enrolled in the study. H pylori status was determined by rapid urease test at entry. After giving written informed consent, the patients were randomly allocated into three groups: group A (n = 120) received a standard 1-wk triple therapy (20 mg omeprazole b.i.d., 1000 mg amoxicillin b.i.d., 500 mg clarithromycin b.i.d.); group B (n = 120) received a 10-d standard quadruple therapy (20 mg omeprazole b.i.d., 1000 mg amoxicillin b.i.d., 240 mg colloidal bismuth subcitrate b.i.d., and 500 mg metronidazole b.i.d.); group C (n = 120) received 375 mg sultamicillin (225 mg ampicillin plus 150 mg sulbactam, purchased from Pfizer SA, Case Postale, 8048 Zurich, Switzerland) b.i.d. (before breakfast and dinner), instead of amoxicillin in the standard quadruple therapy for the same duration. H pylori eradication was confirmed by C14-urea breath test following 6 wk from the end of therapy.

    All patients were contacted periodically, asked about the occurrence of possible side effects, and appropriate guidance was provided when needed

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