Agustos 2014
Helicobacter pyloriinfeksiyonlu genç hastalarda tedavi seçenekleri; Standard üçlü veya bismuth bazli dörtlü tedavi
Treatment choices in young patients with Helicobacter pylori infection: Standard triple or bismuth-based quadruple therapies
- Ana Sayfa
- Sayılar
- Agustos 2014
- Helicobacter pyloriinfeksiyonlu genç hastalarda tedavi seçenekleri; Standard üçlü veya bismuth bazli dörtlü tedavi...
Özet
Giris ve Amaç: Helicobacter pylori dünyada tüm yas gruplarinda en sik görülen gastrik patojen olup bu patojenin eradikasyon oranlari gün geçtikçe azalmaktadir. Bu çalismanin amaci dispepsisi olan Helicobacter pylori pozitif genç hastalarda standard üçlü ve bizmut bazli dörtlü tadavilerin basari oranlarini belirlemek ve tedaviye cevapsizlik durumunda levofloksasin bazli üçlü ve yine bizmut bazli dörtlü ikinci basamak tedavilerinin basari oranlarini saptamaktir. Gereç ve Yöntem: Otuz bes yas alti 116 Helicobacter pylori pozitif dispepsili hasta çalismaya alindi. Hastalar iki gruba ayrildi bir gruba lansoprazol 30 mg bid, amoksisilin 1 gr bid, klaritromisin 500 mg bid 14 günlük tedavi diger gruba bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid 14 günlük tedavi olarak verildi. Tedaviye yanitsiz olgulara, levofloksasin, amoksisilin, lansoprazol veya bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid tedavileri ikinci basamak tedavi olarak verildi. Bulgular: Helicobacter pylori eradikasyon oranlari bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid grubunda %85.7 ve lansoprazol 30 mg bid, amoksisilin 1 gr bid, klaritromisin 500 mg bid grubunda %63.3 bulundu. Istatistiksel olarak sigara, alkol ve nonsteroid-antiinflamatuvar kullaniminin tedavi cevabi üzerinde hiçbir etkisi bulunmaz iken tedaviyi etkileyen tek faktörün bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid tedavi seçenegi oldugu belirlendi. Tedaviye yanitsizlarda ikinci basamak tedavi olarak lansoprazol 30 mg bid, amoksisilin 1 gr bid, klaritromisin 500 mg bid grubunda olanlara bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid ve bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid grubunda olanlara levofloksasin, amoksisilin, lansoprazol tedavisi verildi, her iki grupta da ikinci basamak tedavi ile %70 oraninda basari elde edildi. Sonuç: Klaritromisine duyarli olmasini bekledigimiz genç hastalarda dahi Helicobacter pylori eradikasyon oranlari lansoprazol 30 mg bid, amoksisilin 1 gr bid, klaritromisin 500 mg bid grubunda düsük olup bu hastalarda da bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid tedavisi ilk basamak tedavi olarak düsünülmelidir. Ilk basamak tedaviye yanitsiz gençlerde ikinci basamak tedavi seçeneklerinden bizmut subsalisilat 300 mg qid, lansoprazol 30 mg bid, metronidazol 500 mg tid, tetrasiklin 500 mg tid ve levofloksasin, amoksisilin, lansoprazol arasinda fark olmadigi saptanmistir.
Abstract
Background and Aims:Helicobacter pylori is the most abundant pathogen in all age groups worldwide, and eradication rates of this pathogen are decreasing over time. We aimed to determine the efficacy rates of standard triple and bismuth-based quadruple therapies in young patients with dyspepsia, and in the event of eradication failure, to assess the success rates of rescue treatments with bismuthbased quadruple or levofloxacin-based triple protocols. Materials and Methods:A total of 116 Helicobacter pylori -positive young patients (≤35 years old) with dyspepsia were given either lansoprazole 30 mg bid, amoxicillin 1 g bid, and clarithromycin 500 mg bid for 14 days or bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid for 14 days. In case of eradication failure, levofloxacin, amoxicillin, and lansoprazole or bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid therapies were given as rescue treatments. Results:Helicobacter pylori eradication rates were 85.7% in the bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid group and 63.3% in the lansoprazole 30 mg bid, amoxicillin 1 g bid, and clarithromycin 500 mg bid group. Smoking, alcohol, and nonsteroidal antiinflammatory drug use had no effect on response; the only factor affecting the response rate was bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid treatment. The nonresponder patients in the lansoprazole 30 mg bid, amoxicillin 1 g bid, and clarithromycin 500 mg bid group and bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid groups were given bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid and levofloxacin, amoxicillin, and lansoprazole rescue treatments, respectively, and a 70% success rate was achieved in both groups. Conclusions:Even in young patients, who are supposed to be susceptible to clarithromycin-based treatment, the Helicobacter pylori eradication rates were lower with lansoprazole 30 mg bid, amoxicillin 1 g bid, and clarithromycin 500 mg bid treatment; thus, bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid protocol should be preferred as first-line treatment. There was no difference between the second-line treatment response rates of levofloxacin, amoxicillin, and lansoprazole and bismuth subsalicylate 300 mg qid, lansoprazole 30 mg bid, metronidazole 500 mg tid, and tetracycline 500 mg tid protocols
