文档介绍：VOLUME 65, NO. 1, JANUARY/FEBRUARY 2004
Second-Line and Third-Line Trial for Helicobacter
pylori Infection in Patients with Duodenal Ulcers:
A Prospective, Crossover, Controlled Study
GyOrgy M. Buz~s, MD, 1 Hajnalka Gy6rffy, MD, 2 Ilona Sz~les, MD, 3
and Anna Szentmih~lyi, MD 4
1Department of Gastroenterology, Ferencvdros Health Center, and 22nd Institute of
Pathology, Semmelweis University, Budapest, Hungary, 3Central Laboratory, 2nd
District Health Center, Budapest, Hungary, and 4Department of Bacteriology, Johan
B~la National Institute of Epidemiology, Budapest, Hungary
ABSTRACT
Background: Following standard first-line triple therapies for Helicobacter
pylori infection, up to 20% of patients require further eradication.
Objective: The aim of this study was to assess the effects of second-line
triple therapies and third-line quadruple therapies for the eradication of
H pylori.
Methods: This 7-week, prospective, crossover, controlled, second- and
third-line trial was conducted at the Department of Gastroenterology, Ferenc-
v~os Health Center (Budapest, Hungary). Patients aged 18 to 80 years with
duodenal ulcers and an H pylori infection resistant to first-line triple therapy
(pantoprazole 40 mg BID + amoxicillin 1000 mg BID + clarithromycin 500 mg BID
[PAC] given as tablets) received a different triple therapy regimen (ranitidine
bismuth citrate 400 mg BID + metronidazole 500 mg BID + clarithromycin
500 mg BID [RBC-MC]) for 7 days (group 1A), and nonresponders after RBC + 2
antimicrobials received the pantoprazole-based regimen (group 1B). After sec-
ondary failure, patients were randomized to receive quadruple therapies:
pantoprazole, amoxicillin, tetracycline, and either nitrofurantoin or bismuth
subsalicylate (groups 2A and 2B).
Results: One hundred thirty-four patients were enrolled in the second-line
study