https://scholars.lib.ntu.edu.tw/handle/123456789/541037
標題: | Empirical modified sequential therapy containing levofloxacin and high-dose esomeprazole in second-line therapy for Helicobacter pylori infection: A multicentre clinical trial | 作者: | JYH-MING LIOU CHIEH-CHANG CHEN MEI-JYH CHEN Chang C.-Y. YU-JEN FANG Lee J.-Y. WANG-HUEI SHENG HSIU-PO WANG MING-SHIANG WU Lin J.-T. |
公開日期: | 2011 | 卷: | 66 | 期: | 8 | 起(迄)頁: | 1847-1852 | 來源出版物: | Journal of Antimicrobial Chemotherapy | 摘要: | Objectives: Sequential therapy appears to achieve a higher Helicobacter pylori eradication rate than triple therapy. We assessed the efficacy and tolerability of modified sequential therapy containing levofloxacin and high-dose esomeprazole in second-line therapy. Methods: Patients who failed first-line triple therapy with clarithromycin, amoxicillin and a proton pump inhibitor were eligible in this multicentre trial. Eligible patients were treated with esomeprazole 40 mg and amoxicillin 1 g for the first 5 days, followed by esomeprazole 40 mg, levofloxacin 250 mg and metronidazole 500 mg for another 5 days (all given twice daily). Eradication was confirmed with a 13C-urea breath test 6 weeks after therapy. Drug susceptibility, presence/absence of gyrA mutation and CYP2C19 genotype were also determined. Results: A total of 142 patients were enrolled. The eradication rate was 95.1% [135/142, 95% confidence interval (CI) 91.5%-98.6%] in the intention-to-treat analysis and 96.4% (133/138, 95% CI 93.3%-99.5%) in the per protocol analysis. Four patients (2.8%) failed to take at least 80% of the drugs due to adverse effects. The eradication rates were 50% (4/8) and 97.7% (43/44) in patients with and without metronidazole resistance, respectively (P=0.001). The eradication rates were 84.6% (11/13) and 95.1% (58/61) in patients with and without gyrA mutation, respectively (P=0.210). The eradication rates were not affected by the CYP2C19 polymorphism (P=0.421). Conclusions: This modified sequential therapy achieved an excellent eradication rate (>95%) in second-line treatment and the eradication rate appeared to be affected by metronidazole resistance. ? The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-79960458098&doi=10.1093%2fjac%2fdkr217&partnerID=40&md5=20b9e254719437569b95240bab4da181 https://scholars.lib.ntu.edu.tw/handle/123456789/541037 |
ISSN: | 0305-7453 | DOI: | 10.1093/jac/dkr217 | SDG/關鍵字: | amoxicillin; carbon 13; clarithromycin; cytochrome P450 2C19; DNA topoisomerase (ATP hydrolysing) A; esomeprazole; levofloxacin; metronidazole; proton pump inhibitor; abdominal pain; adult; antibiotic resistance; antibiotic sensitivity; antibiotic therapy; article; bacterial genome; bloating; clinical effectiveness; combination chemotherapy; constipation; diarrhea; dizziness; DNA polymorphism; drug megadose; drug withdrawal; eradication therapy; female; gene mutation; genotype; headache; Helicobacter infection; Helicobacter pylori; human; major clinical study; male; multicenter study; nausea; patient compliance; rash; sequential therapy; taste disorder; treatment duration; treatment failure; treatment withdrawal; urea breath test; vomiting; Adult; Aged; Anti-Bacterial Agents; Aryl Hydrocarbon Hydroxylases; Breath Tests; DNA Gyrase; Drug Monitoring; Female; Genotype; Helicobacter Infections; Helicobacter pylori; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Ofloxacin; Omeprazole; Prospective Studies; Treatment Outcome; Urea |
顯示於: | 醫學系 |
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