Bismuth-Based Quadruple Therapy versus Metronidazole- Intensified Triple Therapy as a First-Line Treatment for Clarithromycin-Resistant Helicobacter pylori Infection: A Multicenter Randomized Controlled Trial

被引：10

作者：

Seo, Seung In ^{[1
,2
]}

Lim, Hyun ^{[2
,3
]}

Bang, Chang Seok ^{[2
,4
]}

Yang, Young Joo ^{[2
,4
]}

Baik, Gwang Ho ^{[2
,4
]}

Lee, Sang Pyo ^{[2
,5
]}

Jang, Hyun Joo ^{[2
,5
]}

Kae, Sea Hyub ^{[2
,5
]}

Kim, Jinseob ^{[6
]}

Kim, Hak Yang ^{[1
,2
]}

Shin, Woon Geon ^{[1
,2
]}

机构：

[1] Hallym Univ, Kangdong Sacred Heart Hosp, Coll Med, Dept Internal Med, Seoul, South Korea

[2] Hallym Univ, Inst Liver & Digest Dis, Chunchon, South Korea

[3] Hallym Univ, Sacred Heart Hosp, Coll Med, Dept Internal Med, Anyang, South Korea

[4] Hallym Univ, Chuncheon Sacred Heart Hosp, Coll Med, Dept Internal Med, Chunchon, South Korea

[5] Hallym Univ, Dongtan Sacred Heart Hosp, Coll Med, Dept Internal Med, Hwaseong, South Korea

[6] Seoul Natl Univ, Grad Sch Publ Hlth, Dept Epidemiol, Seoul, South Korea

来源：

GUT AND LIVER | 2022年 / 16卷 / 05期

关键词：

Helicobacter pylori; Clarithromycin; Drug resistance; Point mutation; Therapy; POINT MUTATIONS; ERADICATION; RATES; GENE;

D O I：

10.5009/gnl210365

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background/Aims: Clarithromycin resistance is a main factor for treatment failure in the context of Helicobacter pylori infection. However, the treatment regimen for clarithromycin-resistant H. pylori infection has not yet been determined. We aimed to compare the efficacy and cost-effectiveness of 14-day bismuth-based quadruple therapy versus 14-day metronidazole-intensified triple therapy for clarithromycin-resistant H. pylori infection with genotypic resistance. Methods: This was a multicenter, randomized, controlled trial. A total of 782 patients with H. pylori infection examined using sequencing-based clarithromycin resistance point mutation tests were recruited between December 2018 and October 2020 in four institutions in Korea. Patients with significant point mutations (A2142G, A2142C, A2143G, A2143C, and A2144G) were randomly assigned to receive either 14-day bismuth-based quadruple therapy (n=102) or 14-day metronidazole-intensified triple therapy (n=99). Results: The overall genotypic clarithromycin resistance rate was 25.7% according to the sequencing method. The eradication rate of 14-day bismuth-based quadruple therapy was not significantly different in the intention-to-treat analysis (80.4% vs 69.7%, p=0.079), but was significantly higher than that of 14-day metronidazole-intensified triple therapy in the per-protocol analysis (95.1% vs 76.4%, p=0.001). There were no significant differences in the incidence of side effects. In addition, the 14-day bismuth-based quadruple therapy was more cost-effective than the 14-day metronidazole-intensified triple therapy. Conclusions: Fourteen-day bismuth-based quadruple therapy showed comparable efficacy with 14-day metronidazole-intensified triple therapy, and it was more cost-effective in the context of clarithromycin-resistant H. pylori infection. (Gut Liver, Published online February 11, 2022)

引用

页码：697 / 705

页数：9

共 23 条

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