- 期刊
以含Rifabutin之三合一療法作為幽門桿菌除菌失敗病例之補救治療
Rifabutin-Based Triple Therapy as a Rescue Therapy for Helicobacter Pylori Eradication
摘要
幽門螺旋桿菌感染和消化性潰瘍及慢性胃炎等有密切的關係。目前幽門螺旋桿菌感染第一線治療是以Proton Pump Inhibitor (PPI)結合clarithromycin及amoxicillin或metronidazole (tinidazole)做為期七天的治療，根除率可達90%。第二線藥物，除四合一療法(PPI，bismuth subsalicylate/subcitrate, metronidazole, (or tinidazole)，tetracycline (or amoxicillin))外，亦可改用rifabutin或levofloxacin來作為補救的療法。本臨床試驗是以rifabutin為基礎，結合amoxicillin及esomeprazole的三合一療法，對以第一線藥物治療幽門螺旋桿菌失敗的補救療法。 從2001年10月到2004年12月，對於證實有幽門螺旋桿菌感染病例在施行第一線治療時給予一般標準劑量的三合一療法(esomeprazole 40mg bid，clarithromycin 500mg bid，amoxicillin 1g bid)治療一星期。一個月後，再以碳－13呼氣試驗及快速尿素酶檢驗(RUT)來追蹤治療結果。除菌失敗時，則接著給予rifabutin (150mg)、amoxicillin (1g)及esomeprazole (40mg) bid總計十天的三合一療法。最後以－碳13呼氣試驗及RUT來評斷結果。第一線治療後，檢驗仍呈陽性者，總計收治54名病患。包括男性24位，女性30位，平均年齡53.1歲（20-80歲），胃鏡檢查結果包含胃或十二指腸潰瘍及胃炎。54位病人中，10位病人未回診追蹤，在44位的有效樣本中，本試驗發現經rifabutin為基礎的三合一療法治療後，碳－13呼氣試驗結果由陽性反應轉陰性反應為41位，持續陽性反應的有3位（治療失敗，皆為女性），除菌成功率為93.2%，其中男性21位，占51.2%，女性20位，占48.8%。藥物的副作用包括有胃腸不適(3/44，5.5%)，頭痛(1/44，1.8%)，橘紅色尿液(25/44，57%)。這項試驗結果顯示以rifabutin為基礎結合amoxcillin、esomeprazole的三合一療法，做為第一線藥物治療幽門螺旋桿菌失敗的補救療法時，有良好的除菌效果。
並列摘要
Helicobacter pylori infection is associated with peptic ulcer disease and chronic gatritis. Currently, the first-line therapy for Helicobacter pylori eradication is proton pump inhibitor combined with two antibiotics, amoxicillin, clarithromycin or metronidazole (tinidazole), for seven days. Alternative therapy includes a bismuth based quadruple regimen or a clarithromycin substitution with either rifabutin or levofloxacin. In this study we have tested a triple therapy based on esomeprazole, amoxicillin and rifabutin as a rescue regimen in patients who have failed the first line therapy A total of 54 patients failed the one week triple therapy were treated with esomeprazole, amoxicillin (or tinidazole) and clarithromycin for Helicobacter pylon eradication between October 200] and December 2004. Either a 13C Urea Breath Test or a Rapid Urease Test (RUT) was done one month after the therapy to document the treatment failure. There were 24 male and 30 female patients with their mean age of 53.1 years old. Initial endoscopic findings included both gastro-duodenal ulcers and superficial gastritis. Forty-four patients received rescue therapy with esomeprazole, amoxicillin and rifabutin for 10 days. A repeat Urea Breath Test and RUT confirmed a successful eradication rate of 93.2% (41/44). This result suggested that a rifabutin based triple therapy is a good rescue regimen far Helicobacter pylon eradication.