Alexander C. Ford1, Paul Moayyedi1
1Gastroenterology Unit, City Hospital National Health Service Trust, Birmingham, UK
Tóm tắt
BACKGROUND: The use of Helicobacter pylori eradication therapy is
advocated in an increasing variety of situations. It is therefore important to
optimise current strategies to eradicate H pylori infectionOBJECTIVES: To define the optimum dosage, drugs and duration of
proton pump inhibitor (PPI) triple therapy.METHODS: A review of the literature was performed to identify randomized
controlled trials and systematic reviews addressing these issues.RESULTS: In PPI, amoxicillin and clarithromycin (PAC) based regimens,
twice daily PPI gave optimal eradication rates (relative risk reduction
[RRR] compared with once daily = 7%; 95% CI 2% to 12%), but in
PPI, clarithromycin and metronidazole (PCM) based regimens there was
no difference (RRR = 2%; 95% CI –7% to 10%). Omeprazole and lansoprazole‐
containing triple therapies achieved similar eradication rates, but
rabeprazole appeared superior to omeprazole (RRR = 8%; 95% CI 2% to
14%). The optimum clarithromycin dose in a PAC regimen was 500 mg
twice daily (RRR = 11%; 95% CI = 3% to 18%), but 250mg twice daily
in a PCM regimen (RRR = 2%; 95% CI –4% to 7%). Eradication rates
were lower with a seven day regimen compared with fourteen (RRR =
12%; 95% CI 7% to 17%). Overall there was no difference between a
PAC and a PCM regimen (RRR = 0%; 95% CI –3% to 3%).CONCLUSIONS: PAC and PCM regimens are equally effective if used
optimally, though PCM is cheaper. The eradication regimen and its duration
should be tailored according to the clinical situation.
